Private Medical Insurance

Groundhog22

Sorry for long post, hard to be brief.
ive been in BUPA 49 years from when i was in millitary.
10 years ago i had massive surgical complications in a private hospital. I didn’t know they were permanent at the time - hospital didn’t want to know as they are not accountable.
my BUPA premiums have gone through the roof.
because I’m now very complex ( 2 stoma bags +++) I cannot have major surgery in a private hospital as they can’t cope.
if I need more minor things like cataracts I could use my policy as waiting lists on NHS are many years and I can barely see.
my question is it’s just so unfair to have to pay for an insurance policy that I cannot really access yet BUPA refuse to treat my case as exceptional and reduce the premiums.  They have never heard of an outcome like mine yet I pay the same as everyone else.  Wasn’t the basis of PPI reclaims based on you paying for services you would never be able to access?  So what’s the difference,  I can ill afford £500 a month as I can no longer work. 

Be mindful if you have surgery in a private hospital to ask the question what happens if things go wrong as there is no accountability whatsoever, it’s terrifying,  
im wondering if someone can help please 

BarelySentientAI

Sorry if I sound abrupt - but if you are unemployed and can't afford £500 per month for private medical insurance, then don't have private medical insurance.

Either that or look for a policy that has many many exclusions - don't know how many of them exist, but they would be cheaper.

maman

Not sure where you are in the country but around here (South East England), the waiting list for cataracts definitely isn't years, just a few months. Have you actually been told this? 🤔

DullGreyGuy

Groundhog22 said:
Wasn’t the basis of PPI reclaims based on you paying for services you would never be able to access? 

The real basis of the PPI reclaims was purely opportunistic and only succeeded because of the poor record keeping of banks at the point of sale when regulations were lighter than they are today. There no doubt were some real cases of miss-selling - my ex used to deal with PPI claims (as in claims on the policy not reclaiming premiums) and had once case where the bank gave a £25k unsecured loan to someone with terminal cancer selling them PPI, giving them the claim form at the same time telling them it'll allow them to leave something for their kids. She worked for the bank so these sorts of cases were paid out and it was just a debate on which division of the company should take the hit.

The one that really amused me the other day was a FOS complaint that a person and their friend were made redundant, the friend has claimed on their PPI and their debts were being repaid by the insurance but the complainant had reclaimed their PPI claiming miss-selling and so their PPI provider had declined the claim she lodged saying the policy was cancelled when the premiums were reclaimed. Talk about wanting your cake and eating it!

Groundhog22 said:

I’m now very complex ( 2 stoma bags +++) I cannot have major surgery in a private hospital as they can’t cope.

What's your basis for saying this? Is it possibly more of a local issue? Have you spoken to someone about a particular procedure that they said they couldn't do?

There are general limits on what private hospitals can do, they are often much smaller than NHS, most dont have a critical care unit, over night there may be only a single registrar on duty for the whole place. These fundamental things dont change if you are NHS or privately funded at a private clinic... there are plenty calling them unsafe places for major operations. 

Have you spoken to a broker? There may be policies out there with a lower single claim limit that would effectively block major operations on the basis of cost and therefore provide the level of cover you want? Most people want the opposite, as full cover as possible, and so not something I've looked into. 

With Customer Duty products must represent value for money to the average punter not each and every individual punter. It's not a requirement that absolutely everyone has to be insurable either... try buying Travel insurance as a stage 4 cancer patient with a short life expectancy. 

A broker can at least advise and so you have more grounds for complaint if you raise your concerns and they advise the policy will be suitable rather than an unadvised sale (as all direct purchases will be) where its your obligation to ensure a policy meets your needs and demands.

Groundhog22

maman said:

Not sure where you are in the country but around here (South East England), the waiting list for cataracts definitely isn't years, just a few months. Have you actually been told this? 🤔

Yes it’s a two year wait presently in wales  as I have two stoma bags to deal with it’s becoming very difficult. 

Groundhog22

DullGreyGuy said:

Groundhog22 said:
Wasn’t the basis of PPI reclaims based on you paying for services you would never be able to access? 

The real basis of the PPI reclaims was purely opportunistic and only succeeded because of the poor record keeping of banks at the point of sale when regulations were lighter than they are today. There no doubt were some real cases of miss-selling - my ex used to deal with PPI claims (as in claims on the policy not reclaiming premiums) and had once case where the bank gave a £25k unsecured loan to someone with terminal cancer selling them PPI, giving them the claim form at the same time telling them it'll allow them to leave something for their kids. She worked for the bank so these sorts of cases were paid out and it was just a debate on which division of the company should take the hit.

The one that really amused me the other day was a FOS complaint that a person and their friend were made redundant, the friend has claimed on their PPI and their debts were being repaid by the insurance but the complainant had reclaimed their PPI claiming miss-selling and so their PPI provider had declined the claim she lodged saying the policy was cancelled when the premiums were reclaimed. Talk about wanting your cake and eating it!

Groundhog22 said:

I’m now very complex ( 2 stoma bags +++) I cannot have major surgery in a private hospital as they can’t cope.

What's your basis for saying this? Is it possibly more of a local issue? Have you spoken to someone about a particular procedure that they said they couldn't do?

There are general limits on what private hospitals can do, they are often much smaller than NHS, most dont have a critical care unit, over night there may be only a single registrar on duty for the whole place. These fundamental things dont change if you are NHS or privately funded at a private clinic... there are plenty calling them unsafe places for major operations. 

Have you spoken to a broker? There may be policies out there with a lower single claim limit that would effectively block major operations on the basis of cost and therefore provide the level of cover you want? Most people want the opposite, as full cover as possible, and so not something I've looked into. 

With Customer Duty products must represent value for money to the average punter not each and every individual punter. It's not a requirement that absolutely everyone has to be insurable either... try buying Travel insurance as a stage 4 cancer patient with a short life expectancy. 

A broker can at least advise and so you have more grounds for complaint if you raise your concerns and they advise the policy will be suitable rather than an unadvised sale (as all direct purchases will be) where its your obligation to ensure a policy meets your needs and demands.

Thank you for your reply. 

Yes I can’t get travel insurance either! It’s a nightmare.
i am complex because the condition is rare and unpredictable plus it’s nearly killed me off 3 times.  I think I’ll,be better off cancelling the policy and just hoping for the best ! 

Brie

You say you were in the military.  Have you talked to anyone as SSAFA about this?  Surely you aren't the only case they might have heard about.

sheramber

But you said you can use your  insurance for cataract operations so why cancel before making use it for that?

DullGreyGuy

sheramber said:

But you said you can use your  insurance for cataract operations so why cancel before making use it for that?

And why are you waiting? The benefit of PMI is predominately the speed and secondly the jumping to the most in-depth tests.

Took 8 weeks to get a referral for a joint issue as likely a chronic issue used the same referral for private and NHS. Initial appointment, MRI, follow up appointment and treatment was done in 3 weeks on PMI. Was 5 months for the initial appointment on NHS, literally saw the same consultant but was her colleague thats continued her treatment plan. 

Groundhog22

Thanks everyone for your comments. 

The moral of the story is don’t have major surgery in a private hospital as if it goes very wrong with permanent consequences, there is nothing out there to help.  Too hard to explain.
ssafa have listened but there is nothing that can be done, I am trapped.  Too rare for anyone to care.
thanks again for your suggestions