Private medical insurance claim

Reesha

I had private medical insurance for my husband and I with WPA through work for many years.  My husband had planned private surgery in April that was cancelled due to Covid-19 by the hospital. We informed WPA who said we can have extension for 2 years to have the surgery. Unfortunately, I was made redundant due to Covid-19 on the 5th August therefore the company cancelled my policy. I have spoken to WPA to ask if I can continue the policy self funding so my husbands surgery can be completed which I cannot. They are not honouring the claim that was not completed due to Covid and allowing us to continue the policy payments ourselves until this is sorted. A new policy means waiting two years to be able to complete the surgery under insurance. Is there anything I can do here legally? Do WPA have a duty of care? Many thanks 

TELLIT01

Policy cover ceased when your employment ended.  It's as simple as that if the insurer will not allow you to take over the policy.  I was in a similar position but had surgery through Private Health cover through my employer in the period between the announcement of redundancy and employment ending.  Insurance paid for the surgery and first couple of physio sessions but once my employment ended I had to pay for the physio myself. 

Old_Lifer

As above,   plus  a bulk scheme through the employer was probably cheaper.

Sandtree

Your only option is to try and persist with them allowing you to buy cover but ultimately its their commercial decision.

I had a very favourable policy the last time I was an employee with Bupa that included all the bells and whistles inc pre-existing condition cover. I fortunately wasnt mid claim but wanted to continue the same level of cover and initially Bupa also said no. I did manage to convince them as after first refusal I spoke to the small business team who were more amenable and did come back with a silly price but it showed it was possible so went back to the personal lines guys and they eventually agreed to do it for a much more sensible price (still several times what I was paying as an employee). Unfortunately you have a harder time because of the in progress claim  

TrickyDicky101

Do you know how much self-funding your husband's operation would actually cost - maybe that might be an option?

TELLIT01

Just to clarify my comments above.  I could have taken over the cover but I would have had to do so for minimum of 12 months at £99 per month.  Physio was required for about 3 months and even at private rates it was still much cheaper for me to pay the cost myself.  After 12 months the price would have increased to close on £300 per month!!  No thank you.

Sandtree

TELLIT01 said:

 After 12 months the price would have increased to close on £300 per month!!  No thank you.

PMI is one of those very polarising things, many see it as far too expensive and plenty of others think its worth every penny.

My personal views are coloured by my experience when my father and his twin brother both had their second major heart attacks on the same day (in 1992) and both were determined to need heart bypass surgery... his brother had his surgery paid for by PMI 3 days later, my father was in hospital 5 months before eventually having his on the NHS and dying on the theatre table. Obviously will never know what the outcome would have been had the surgery been done earlier, and in part he was to blame as he always down played how sick he was so others were moved above him in the list but the lack of earlier action was always attributed to his demise.

We've had 3 claims on our PMI since taking it out a decade ago, 1 minor but the other two were headlined at £35k each.. clearly the reality is below that as the insurers get rebates etc but still take a while for the claims to be repaid by premiums. There will be a point however when the question of affordability becomes more significant, and typically when you need it more.

TELLIT01

The figures I quoted were 2005 prices.  God knows what they would be now.  Deciding whether private cover is worthwhile is an entirely personal one and I wouldn't criticise anybody who takes that route.

rs65

Reesha said:

Do WPA have a duty of care?  

They do not a duty of care.  They have a duty to provide the cover as per the policy.