International Medical Debt

LisaW20

Hi, I hope that someone out there has some knowledge they can share - we are desperate for help.

My parents saved up for a holiday and travelled to the USA in June 2014. Whilst there, my mother suffered a massive heart attack and had to have 5 hour double bypass surgery.

They were insured with Capita who have since denied their claim. We have complained and they stayed with their decision. We went to the Ombudsman who upheld the decision. All based on pre-existing medical conditions...my parents are in their 60s and had no idea that if something like this happened to them, they would not be covered. I think it's safe to say that they didn't understand the policy or the wording.

The hospitals have placed all the medical bills with a collection agency in Switzerland - OVAG. We have been corresponding with this company who have managed to get the bills down from over $200k to $72k.

My parents still do not have this kind of money. They're retired and on a state pension. They do however, own their tiny end terrace ex-council house which they have worked all of their lives to pay for.

We have offered re-payments, sent across expenditure forms and tried to offer whatever they can spare a month but it has been rejected.

Will they be forced to sell their home?

There is a lack of support or understanding about this out there. All I know is they aren't getting any younger and are so distressed, upset and desperate.

Any help would be very much appreciated, thanks so much.

sourcrates

Hi,
What an awful situation for them to be in, it should serve as a salutary lesson to always read the small print on policies such as this.

With regard to the debt, I am unsure how enforceable this would be in the UK, it's a very gray area, I suggest you give National debt line a ring, as this is too specific a question for an Internet forum.

https://www.nationaldebtline.org

They can give you much more tailored advise on this.

Pollycat

I think you need proper legal advice.
Some solicitors do a free 30 minute session, maybe ring round some firms in your area.

Or perhaps try CAB although it may be too specific for them.

Do you parents have any legal cover on their house insurance?

Such a sad story.
I hope your Mum is recovering, despite this worry.

Archergirl

Did your mother have heart problems before they went?
What questions were asked about their health when they took out the ins? Why have they declined to pay?
I hope it can be sorted out, what a terrible thing to happen.

peachyprice

Archergirl wrote: »

Did your mother have heart problems before they went?
What questions were asked about their health when they took out the ins? Why have they declined to pay?
I hope it can be sorted out, what a terrible thing to happen.

Unfortunately it doesn't matter whether or not her mother had heart problems before she went, failing to declare ANY medical conditions, related to the incident or not, is grounds to void the policy.

tomtontom

peachyprice wrote: »

Unfortunately it doesn't matter whether or not her mother had heart problems before she went, failing to declare ANY medical conditions, related to the incident or not, is grounds to void the policy.

That's not true. Where a customer has acted in good faith (albeit in ignorance) the Ombudsman will try to look at what the situation would have been had the condition been correctly declared. This usually means excluding related conditions, and/ or making a deduction from any award for what the policy would have cost otherwise. The insurer would need to demonstrate an intention to mislead in order to void the policy.

(That is not to give any hope to the OP - the Ombudsman are generally very generous so if they have not upheld the complaint there must be a strong reason for this.)

katejo

It is examples like this which put me off going to the USA at all. If insurers can refuse on the basis of any minor symptom which hasn't been declared however irrelevant it might be to the specific case then where do we stand?
Maybe, in this case, the OP's parents failed to declare a diagnosed condition? I don't know but it does seem a grey area.

rising_from_the_ashes

tomtontom wrote: »

That's not true. Where a customer has acted in good faith (albeit in ignorance) the Ombudsman will try to look at what the situation would have been had the condition been correctly declared. This usually means excluding related conditions, and/ or making a deduction from any award for what the policy would have cost otherwise. The insurer would need to demonstrate an intention to mislead in order to void the policy.

(That is not to give any hope to the OP - the Ombudsman are generally very generous so if they have not upheld the complaint there must be a strong reason for this.)

Would agree with this ^^

What was agreed at the time they left hospital to return to the UK re the outstanding amount?

I'd be surprised if there was nothing put in place by the hospital in case the insurer denied the claim

LisaW20

Thanks for the advice and the links everyone

My mum has never had any issue with her heart at all (such as Angina, previous attacks etc). t was completely out of the blue. She did have slightly high blood pressure, which was being controlled with medication and which was declared at the time of taking out insurance. The company offered additional insurance to insure against her pre-exisitng medical conditions and they mentioned her past ailments - breast cancer, hip replacement and they also mentioned hypertension.

They denied the claim on the grounds that hypertension was a contributing factor to the heart attack. It wasn't - what caused it was that her artery was a thread of tissue and nothing more. I know the blood pressure can't have helped, but she had perfect blood pressure due to her medication. I know ignorance isn't an excuse, but when my dad declined the additional cover at £500+, I don't think he ever imagined they were not covered for something like this. he just thought why cover against breast cancer etc when she is 5+ years clear?

We tried a solicitor who simply stated that they did not want to take Cigna/Capita on. At the moment, we are working with a legal advisor at Age Concern, but I am now going to get in touch with the National Debt Line too.

Thanks all for your concern and comments. Much appreciated.

immoral_angeluk

Ah, I hate to say it but I can see why they're refusing if they're stating the hypertension was a pre-existing condition. High blood pressure is a huge contributing factor for heart attacks, plus the stress of the flights/heat etc is a recipe for disaster. However it doesn't sound like it was explained very well to your poor parents.
Definitely get some advice from a solicitor.Don't bother with CAB they'll just tell you about complaints process/ombudsmen and accessing a solicitor.

What a horrible situation to be in

Archergirl

Do they have legal cover with their household ins? Not sure if it would cover this but worth an ask if they have it.