AXA healthcare not paying... help.

lukerichardson40

Hi guys,

I am looking for a little help here and wonder if anyone knows what the next steps could be...

I have private medical cover through my company with Axa PPP.

A few weeks ago it was found that I have a benign tumour in my leg attached to the bone. I told axa everything that was going on, had everything pre approved... all scans etc.

The doctor told me that it could be left and MIGHT not do anything. I explained how this is effecting me mentally, knowing it is in there is really hurting me psychologically and I need it out for my own piece of mind. He agreed that mental can be just as bad as physical and booked me in for surgery this Saturday.

Yesterday the insurance called to say they wont pay for it as the doctor has said it is my choice to have it removed.

What can I do? I have a tumour in my leg and the insurance wont help. I am a bit of a mess about it all and dont know what to do. Can anyone offer any kind of solutions? I cant afford to pay for it private. I know there is the NHS and that would be one choice, but I have the insurance for a reason.

Thanks in advance.

Luke

flightinfo

As it is a company policy, is there someone at your workplace you can speak to (eg the administrator of the scheme) as they may well have come across this problem before and be able to give some advice?

lukerichardson40

Thanks flightinfo... I have contacted the lady who is head of our health department. She is going to see what she can do, but is unsure she can do anything as it is in the insurance hands. I will see if we have an administrator for this kind of thing. It is a huge company (one of the big 6 energy lots) so must have someone who deals with it.

I am just shocked and sickened that axa believe having a tumour removed is not important enough to fund. I can see if from their point of view financially, but this is what the insurance is for!

TrickyDicky101

Is it possible you could ask the doctor to change his wording to something along the lines of

"My recommendation ios for patient <Luke> to have the tumour removed because of the deleterious psychological impact its presence is having on him"

I guess it would help having the policy conditions handy and going through them with an extremely fine tooth comb to check what they will and won't cover so that the doctor's wording doesn't stop them paying for treatment.

I don't know if this is possible but it has to be worth trying?

I have very great sympathy for you - it's all very well the doctor saying it can stay there and you might be OK - that will be wonderful comfort to you if it does go malignant and you lose limb - or worse - life.

lukerichardson40

Thanks tricky, I will go over it all as soon as I can.

What you are saying is exactly right... some comfort indeed. And the doctor is right, it could stay there and do nothing to my body, but the damage it is already doing to my mind is something else.

I spoke to the insurance again and tried to explained this again to them and I was amazed. The guy on the phone suggested I go to the NHS, I said that would be fine, except I have private cover so I dont have to use the NHS. He then suggested I go and see a psychiatrist because the doctor said there is physically nothing that needs doing.

I spoke to the doctors secretary and she understood exactly what I was talking about. I am only 29 and this is really effecting me. She is going to contact the insurance, see what they need to hear and ask the doctor to tell them this. Fingers crossed I can still have the operation on Saturday. The way AXA are talking about it you would think it was some kind of cosmetic surgery which I just fancy having done!

InsideInsurance

lukerichardson40 wrote: »

I spoke to the doctors secretary and she understood exactly what I was talking about. I am only 29 and this is really effecting me. She is going to contact the insurance, see what they need to hear and ask the doctor to tell them this. Fingers crossed I can still have the operation on Saturday. The way AXA are talking about it you would think it was some kind of cosmetic surgery which I just fancy having done!

Sounds like the doctor has shot you in the foot.

Insurance is there for what is necessary and not elective procedures, by how your doctor worded his response he has evidently made it appear as not being necessary. Whilst he can submit additional documents the insurers are going to be naturally concerned that he is now just trying to manipulate things to get the job than giving a genuine/ professional opinion.

It is possible to get opinions changed but its always best to get things right first time. I'd guess your doctor (or whoever penned the letter for him if not him) is not very experienced in dealing with insurers.