Insurance company saying that my referral does not echo any health issues and they won't cover my me

hopeitwill

Hi everyone,

I have been to my GP a month ago and they found a new heart murmur and gave me a referral for a specialist to have deeper look at it. I wanted to go to a specialist with this and I have private health insurance but my insurance company is saying that the doctor does not echo any health concern in his referral and they would not be covering my specialist consultation.

How can this be and is there any recourse I can take against it? They're saying that it is a personal choice if I would like to have a consultation but not a health concern. I've been paying money for this insurance for some time now, and I can't believe that they can say that.

What should the GP write in their letter that it would say it is a health concern but not a personal choice?

[Deleted User]

The GP won't be able to write anything, as they almost certainly don't know what it is, if anything. It's a personal choice to have it checked out. 

If there is then a diagnosis for a condition which is covered, that is where your insurance will kick in. 

hopeitwill

So with an insurance policy that I had been paying for years, my GP finds something wrong with me, I need to get it checked out first privately by paying for it myself (or wait a year for NHS) and if there is something wrong found by the specialist then my insurance pays for the rest of my treatments? How ridiculous does that sound? My OH waited for 11 months for a specialist to have a look at his own condition on NHS but went to a private specialist in the end and his claim was accepted by his insurance company.

[Deleted User]

The referral is to find out if there is anything wrong with you. Don't put yourself into an early grave yet. 

But let's hope there's nothing wrong and you never need to use your insurance.

sheramber

According to the MAYO clinic 
A murmur that happens when the heart is filling with blood (diastolic murmur) or throughout the heartbeat (continuous murmur) may signal a heart problem. Tests need to be done to find the cause. A murmur that occurs when the heart is emptying (systolic murmur) generally is an innocent heart murmur. Innocent heart murmurs aren't a sign of heart disease and don't require treatment.

does your heart murmur come into the latter category?

hopeitwill

sheramber said:

According to the MAYO clinic 
A murmur that happens when the heart is filling with blood (diastolic murmur) or throughout the heartbeat (continuous murmur) may signal a heart problem. Tests need to be done to find the cause. A murmur that occurs when the heart is emptying (systolic murmur) generally is an innocent heart murmur. Innocent heart murmurs aren't a sign of heart disease and don't require treatment.

does your heart murmur come into the latter category?

Thanks @sheramber, mine is the latter, I think, that's why the GP was concerned. And I've had blood tests done which had some higher than normal figures and I keep a journal of my blood pressure for further testing. This is why when I had a response like that was kind of surprising and thought maybe the referral letter lacked "medical concern".

sheramber

But the latter is not a sign of heart  disease and does not need treatment.
 A murmur that occurs when the heart is emptying (systolic murmur) generally is an innocent heart murmur. Innocent heart murmurs aren't a sign of heart disease and don't require treatment.