NDP Dental insurance - cheating

truthman007

Hi There,

One of my friend is with NDP dental insurance and pays around monthly £25, He had a dental problem went to see NHS and was told this can be treated at private only. He also checked several places around his areas and noone is having that treatment at NHS. Then decided to go with private and pay the amount and when he claimed the money back to NDP they came back and said this is available at NHS at the cost of 10% of the cost of private treatment.

How can he get the full claim money back from them as they use some loop holes to escape. When he joined he had a single paper that was telling all the treatments at NHS and if there is anything not covered by NHS can get treatment at private and will be paid 100%.

Thanks

fluffnutter

If you buy insurance surely you can use it, regardless of whether or not the treatment is also available on the NHS?

That's a bit like using your BUPA insurance to get a knee replacement (because it's quicker, say) only to be told by BUPA 'The NHS does knee replacements'. Well, yes, of course it does. So what?

What are the T&Cs of the policy? Do they really preclude treatment that's also available on the NHS? If so, why on earth has he bothered throwing away £300 a year on such a rubbish policy?

If the conditions do prevent him claiming for something that's available on the NHS, he needs to go back to the NHS surgeries he first consulted and ask them to confirm in writing that they refused to treat him. He can then present this to the insurance company.

One other thing... and I confess I don't know much about medical insurance at all (as you can probably tell!)... is it the sensible thing to agree with the company that they'll foot the bill before going ahead with treatment? Perhaps he should have done that but I don't really know how these things work...

truthman007

As per the policy terms, eligible for private but the treatment cost will be the same as NHS if the treatment is available at NHS. NHS may have only one place somewhere in UK, could not find any place so far. NDP use that as reference and refuse to pay the full money back.

SuperHan

Why didn't he ask his insurance company first? I think if I intended to claim costs back I would first check I definitely was covered.. But hindsight and all that.

truthman007

This is risk of loosing teeth, needs to get it done either case, even if they say 'cant give the full money back' before treatment, cant stop the treatment.

londondent

Most treatments are available under the NHS. However this may not include any cosmetic treatment or treatment with a specialist. For example a root canal treatment is available for the miserly fee of £48. However privately may cost as much as £400, or even £800 with a specialist doing the treatment ;if the treatment was deemed to complicated to handle by a general dentist.

Could you possibly give any more details as to what type of treatment he/she was having done?? And why the NHS practices could not offer the treatment under the NHS?

Some dental plans are absolutely rubbish and you may well end up paying in more than you'll ever get out of them!

fluffnutter

It begs the question.. what's the point of this policy? A dentist is just a dentist regardless of whether he or she treats NHS patients or not, and pretty much all treatments could be eligible for NHS funding in some circumstances, even cosmetic work.

Basically then, the company's always going to be able to say, 'actually you can get that on the NHS, so we're dramatically reducing the value of your claim'. Being an insurance company hence not given to sense or compassion, they won't care that the NHS has refused to actually fund the work (as we all know it's a bit of a postcode lottery out there). No, they'll just trawl their books to discover that the work's been offered once, to some old dear on a Scottish island and the NHS agreed to foot the bill and use that as evidence that this is 'work that can be done on the NHS'. Try arguing with that.

What's the point in paying £25 a month for a policy like that? It's throwing money away, frankly.

bris

It's called due dilligence, you should have checked before you had the work done.

In the insurers defence, they can't possibly just pay out on the ops say so, even if they didn't just use NHS costings they would need some sort of control in place, a Hollywood type dentist charge double the price of a normal private dentist, they would need some sort of control in place as no two dentists would charge the same. It will be perfectly clear that they need to appove the work in the T&C's.