private heath care

parikoo

i & family have had private hc for 10 years and have paid to the company in question neally 30K. Back in january i made a claim and everything was authorised to go ahead.However because our yearly plan was up for for renewal in february we decided that is was too expensive to continue.so i canx the policy, which ended on the 3rd feb. Now I had my minor op on 6th Feb which had been authorised back in january. they are now REFUSING to pay because"the policy was not paid up to date"? I am sickenend by this being the only claim i have made in 10 years help me please someone i have written to them but somehow they only contact me by phone????We are talking in the region of 600 pounds.i am mad mad mad to have continued this policy i could have put this money in an account and used this money for private care i AM DUMB. Please heed this warning....sorry to whaffle on....i did talk to the doctor that performed my op he said its always usefull to talk to doc's if your paying cash.....

mattymoo

Not an expert in how private medical cover is written but with all insurances there is a crucial date and it varies from policy to policy.

On some, it is the date of the incident that gives rise to the claim - e.g. motor accident or storm damage to a house.

On some policies it is the date the claim is made. This usually relates to professional indemnity policies where the negligent act could have occured 5-10 yrs earlier. The policy in force on the date the claim is made pays out.

In your case, the crucial date appears to be the date the treatment is undertaken and to me that seems acceptable. With medical cover the treatment could involve several procedures / ops and follow up visits that go on for months if not years. Would you expect them to pay those even though you have cancelled the cover? I know the date difference is only 3 days but to be honest, you were a bit daft to cancel mid way through a claim.

parikoo

Thank for your info:

If I did not canx at that time i would have been liable for the whole year. I get your point, but they did know what my op was, hence a code given by the doctor to them, they knew it would not last months or years...
So it seems i do not have a leg to stand on?

katetn4

Hi there
I work for a private health insurer and even if somehing is authorised previously then if the member cancels their policy then any treatment they have after that cancellation date wont be paid for. Some companies detail in their handbooks that any verbal authorisation stands as long as there are no changes in circumstances which could affect the claim. In this case it would be you canceling your policy, so I dont think you would be able to contest this.
It is really annoyting I know and a similar thing happened to me but best to chalk it to experience and move on!