Health Insurance company wrongfully declined Cancer care

Eschatologist

Unfortunately my partner was diagnosed with Breast Cancer.

I've had private health care for many years and she was added last year.

When we got the diagnoses the Health Insurance company declined it as they said it was preexisting, this was wrong and I have successfully challenged it, they have apologised but this it has taken a long time and thankfully the NHS where able to treat her in a matter of weeks.

They've offered us £100 as a good will gesture which I've found incredibly insulting because they've effectively denied her the option to use care we are paying for which could have yielded different treatment options, levels of care and experience.

I'm interested in what would be considered reasonable compensation considering the magnitude of the failure we've encountered. 

dunstonh

I'm interested in what would be considered reasonable compensation considering the magnitude of the failure we've encountered. 

£100 is a bit on the light side.  Maybe £250 would be closer to the mark.      

Penguin_

I'd probably ask for the premium of adding your wife to the policy for the year to be refunded.

swingaloo

I was thinking like Penguin as I thought you should ask for your premiums back. On second thoughts though I would be wary of doing that, if your wife should need more cancer care going forward then you really need to leave the plan in place as you will not be able to get the cover anywhere else with the condition now being pre-existing.

I would accept the hundred pounds and be thankful that your wife got the care she needed even if not private care.

LightFlare

Where I worked - cancer care was identical whether private or NHS. 

You may have gotten a slightly better chance of seing the actual consultant (not always the best thing) and sometimes a choice of appointments- but the core care and time scales were identical.

DullGreyGuy

You can search decision made by an Ombudsman at the Financial Ombudsman on https://www.financial-ombudsman.org.uk/decisions-case-studies/ombudsman-decisions, so these are the escalated complaints. You may be able to find cases where a declined PMI was considered wrong and treatment was done via NHS and what compensation they were awarded. 

What is appropriate will depend on what the real world impact it had... is there a treatment they could have received but didnt? There are some that private may cover and NHS generally doesnt but it is vastly more specific than simply "breast cancer". Similarly there are "experimental" treatments but clearly there is no guarantee experiments work. 

Was there any delay? NHS tends to be fairly quick with Cancer so may or may not have any. 

Compensation is based on what did happen not what could have happened. 

Penguin_ said:

I'd probably ask for the premium of adding your wife to the policy for the year to be refunded.

You can ask, ultimately they are still having cover for the remainder of the year etc and it would seem coincidental that the level of impact happens to be identical to the premium

Eschatologist

DullGreyGuy said:

You can search decision made by an Ombudsman at the Financial Ombudsman on https://www.financial-ombudsman.org.uk/decisions-case-studies/ombudsman-decisions, so these are the escalated complaints. You may be able to find cases where a declined PMI was considered wrong and treatment was done via NHS and what compensation they were awarded. 

What is appropriate will depend on what the real world impact it had... is there a treatment they could have received but didnt? There are some that private may cover and NHS generally doesnt but it is vastly more specific than simply "breast cancer". Similarly there are "experimental" treatments but clearly there is no guarantee experiments work. 

Was there any delay? NHS tends to be fairly quick with Cancer so may or may not have any. 

Compensation is based on what did happen not what could have happened. 

Penguin_ said:

I'd probably ask for the premium of adding your wife to the policy for the year to be refunded.

You can ask, ultimately they are still having cover for the remainder of the year etc and it would seem coincidental that the level of impact happens to be identical to the premium

Thanks for this, this is exactly what I was looking for and I'm really shocked  to see people are being offered way more compensation for much more trivial things!