Bupa will not pay claim

Jaybank

I have been a member of BUPA for over 40 years, myself and my family and my senior employees.

I asked BUPA for an authorisation code to go and see a cardiologist due to chest pains. They gave me an authorisation number.
I visited the cardiologist at 8am on Friday the 20th of January 2017 for a stress test. After 3 minutes the cardiologist stopped the treadmill as he saw a problem on the ECG. He spoke to his colleague who works with him and they decided I needed an angiogram immediately followed by surgery if necessary.
I was admitted to the cardiology unit at 10am, given an angiogram and told that they would need to insert a stent immediately into one of my arteries which was 99% blocked. I returned a few days later and they inserted another 4 stents due to blocked arteries.
I rang Bupa on 30th of January and they asked me for the codes of the procedures carried out. I gave them the codes and they said they would pay for the second procedure but not the first. I pointed out to BUPA that the situation was so serious and traumatic at the time that the last thing on my mind was ringing BUPA just before going into the operating theatre at such short notice. Surely they must realise that giving authorisation for a stress test has a good chance of developing into a major medical problem.
Next day they said they would pay nothing because the surgeon is not a BUPA doctor.
BUPA have taken over 100k from me over the years yet now refuse to pay a bill of £2,200. They are looking at every excuse not to pay a legitimate claim.
Quite simply I needed urgent surgery, I was insured, the procedure was carried out and now they will not pay.

Nick Hanley

csgohan4

The importance here will be what lies in the Terms and conditions, not what is morally right.
Also the call handlers here are not medically trained.

I don't have Bupa myself, thought it would be too expensive at 50 pounds a month, which I would rather spend on Life assurance.


To be blunt it's nothing personal, it's business, loyalty doesn't pay now a days

Quentin

Assuming you want advice and not just to rant, then you can make a complaint that they are not treating you fairly. Their complaints procedure will be set out in the policy docs.

If unhappy with the reply you can escalate to the FOS for their adjudication at no cost to you

If that fails then you have the Court as your last resort, though that would involve you in costs initially which you can only recover if you win, so best to get legal advice on your chances of winning before starting that route