Nasty surprise - private medical consultation / tests have exceeded Bupa policy limit

laurat

Hi there,

I have a Bupa policy through work and have recently undergone a cardiologist consultation and outpatient tests. I obtained pre-authorisations from Bupa as required but was warned by them that these would be subject to a sub-limit within the policy. I therefore advised the cardiologist of that sub-limit and enquired how much everything would cost, to which he assured me that the sub-limit would not be breached.

Lo and behold I have just received a letter from Bupa advising that the sub-limit has been (significantly) exceeded and instructing me to pay the difference.

I am furious. This is the first time I have gone private and not a decision I took lightly. I cannot afford to contribute £100s of my own money, nor do I feel I should have to, and I don't see what more I could have done other than alert the cardiologist to the sub-limit. After all, he is the expert - I had absolutely no way of knowing how much his services and the tests would cost.

I will obviously be taking this up with the hospital after the bank holiday, but I wanted to know how anyone else who may have been in this position got on? Is it likely that the hospital will admit an error has been made and waive the shortfall? I presume there is no point involving Bupa in my complaint as they are not at fault?

Unfortunately as a result of my test results I already have a further consultation arranged, which I will now need to carefully consider....

Any thoughts or tips would be appreciated.

Many thanks

Laura

Wutang_2

You think the hospital is at fault and not Bupa??? Most of this country blindly believe everything Bupa says. They have fee guidelines based on 1992's rates and (if you were to ask the majority of private specialists) will flatly refuse to pay for many standard scans and tests. Sorry to hear about your predicament but this is no way the fault of the hospital....I could go on!!

laurat

Wutang,

Thanks for your response, although I must admit it was not what I was expecting! Some more info would be good please.

Having now seen how much these tests costs I can absolutely see that Bupa's sub-limit is ridiculously low, but I have to be realistic in that that is the insurance contract that applies to me. Do you really not think the cardiologist was in any way at fault for giving me incorrect information when I queried costs with him in advance?

I'm interested to hear your (and anyone else's views).

Many thanks

Laura

ACG

Im confused how you could blame bupa?

Bupa have a limit, which the OP post admits she was clearly told.
The OP told the Hospital, and the hospital said there would be no issue.
The hospital were wrong, as there is.

I would be complaining to the hospital too personally.

Im no expert on this, but it just seems the logical option.

mikey72

If you clearly told the hospital how much was authorised, it was the responsibility of the hospital to advise you if that would be sufficient as they did, then to advise you again if the limit had been reached before undertaking any further work.Write to them, and refuse any charge in excess of the pre agreed limit, as no funds had been authorised for it. The further consutation could be an issue, you may find it will be bumped to the NHS, but I would initially try to include that in the services agreed for the initial sum you advised them of, and request them to honour it.

squiggler_2

Hi
I would check with BUPA regarding the next consultation, it may still be covered. My employer's policy has a limit for tests and a separate limit for consultations and yet a third limit for procedures.
Every test and procedure has a code which is how the billing is done. Is it possible to check that all the codes are correct? (ie is it possible to find a test that could have been charged as a procedure and therefor the payment comes from a different 'pot' under the policy)
Good luck, I hope your test results are good news.

Wutang_2

ACG wrote: »

Im confused how you could blame bupa?

Bupa have a limit, which the OP post admits she was clearly told.
The OP told the Hospital, and the hospital said there would be no issue.
The hospital were wrong, as there is.

I would be complaining to the hospital too personally.

Im no expert on this, but it just seems the logical option.

Clearly not an expert - if you get told you have comprehensive cover, would you then think all was covered in full? Answer this and then look at Bupa's fee guidelines.

......and if you can find Bupa's fee guidelines, you are a miracle worker.

mikey72

Wutang wrote: »

Clearly not an expert - if you get told you have comprehensive cover, would you then think all was covered in full? Answer this and then look at Bupa's fee guidelines.

......and if you can find Bupa's fee guidelines, you are a miracle worker.

I can't think of any insurance that's a bottomless pit. Car, house, travel, liability, all have ceilings on them. I would expect Bupa to be the same. I can't argue over the amount, but likewise, we can't argue the op wasn't advised of it in advance, and likewise the consultant.

Wutang_2

mikey72 wrote: »

I can't think of any insurance that's a bottomless pit. Car, house, travel, liability, all have ceilings on them. I would expect Bupa to be the same. I can't argue over the amount, but likewise, we can't argue the op wasn't advised of it in advance, and likewise the consultant.

Some insurers do not have fee guidelines and will pay whatever it costs. Bupa's are based on 1992 costs, so I agree that there is no 'bottomless pit' but there are other insurers who are fairer.

starrystarry

Wutang wrote: »

Some insurers do not have fee guidelines and will pay whatever it costs. Bupa's are based on 1992 costs, so I agree that there is no 'bottomless pit' but there are other insurers who are fairer.

Perhaps so but that doesn't make this Bupa's fault. The policy has a limit, they pointed this out to the OP. It's the hospital's fault the limit was exceeded.

ACG

Wutang wrote: »

Clearly not an expert - if you get told you have comprehensive cover, would you then think all was covered in full? Answer this and then look at Bupa's fee guidelines.

......and if you can find Bupa's fee guidelines, you are a miracle worker.

I agree with Mikey, comprehensive doesnt mean its unlimited.
Im fully comp on my car, i know for a fact it has maximum payouts....Bupa confirmed the limits to the OP in a phone conversation.

If they had said "you have comprehensive cover, we will cover everything" then yes i would be complaining to Bupa - but that isnt the case.

As i said im no expert and im more than open to be shown im wrong, but i dont feel "comprehensive cover" justifies being covered for anything and everything.