BUPA Treatment and Care exclusions for pre-op surgical consultations and some tests

caveman8006

For many years I have suffered from an asymptomatic leaky heart valve which has been regularly monitored by my NHS consultant. My condition has recently deteriorated and I was referred to the surgical MDT review committee run by the specialist London hospital paired with my NHS trust, which recommended me for surgery. Given an estimated waiting list of at least 8 months, I decided to invoke my private health cover. After discussing the claim with BUPA I chose a surgeon and arranged a consultation to discuss the details of the operation with him (type of valve to use, date for the operation, long-term prognosis etc.) at which it was explained that I would also need a pre-op CT scan to check the condition of the aorta. Although my cover (BUPA Treatment and Care) specifically excludes pre-diagnosis consultations and tests, I had already checked all this with the BUPA agent who confirmed that this would not apply to those items directly associated with the surgery itself. However, the £140 consultation fee was subsequently rejected by BUPA on the basis that it was specifically not covered as it preceded treatment (although they subsequently agreed to grant an exception given the "incorrect" advice given by the agent). Strangely, however, the (much more expensive) pre-op CT scans were covered without quibble, but an accompanying blood test (requested on the day, so not specifically pre-authorised) was not. This seems to be a strangely grey area: to my mind, the initial consultation with the surgeon and associated pre-op tests should all definitely be covered as they are essential pre-requirements of the surgical procedure itself and were all incurred post-"diagnosis", which is the form of words used in all the BUPA advertising/policy documents. Has anyone else been caught by this?   

DullGreyGuy

Have a different policy with BUPA, never had a problem but they key is always to ensure you have the pre-approval before proceeding with treatment/tests/appointments etc. Never had problems getting it for small things, for big things the consultants are involved and whilst I've been told its unlikely something would be approved ultimately it all was and so were able to proceed without concern if the bill will be picked up. 

Clearly not everyone does though, was in for treatment the other day and a long argument was going on with someone who was refusing to pay and the receptionist