Private health insurance question (Beneden Healthcare)

HayleyD83

Hello All, 

Looking for some advice if possible. My mum pays into a scheme with Beneden Health (for past 3 years) Recently she had an injury which has turned out to be a chipped bone in the ankle. The GP sent her to hospital who then did and X Ray and found the fracture. She has been advised that she needs to see an Orthopedic consultant and went to raise a claim with Beneden who have told her she is not covered because she already had a diagnosis? To me this seems like it can't be right? Was she supposed to raise a claim with them when she had a sore ankle and did not know what the issue was? Would they have then sent her to a private hospital for an X Ray? As I understand it you can't raise a claim without a GP referral so how else would she be able to get a referral other than through investigation of the injury. They are insisting she has no claim but I am struggling to see how this can right. If anyone has any information I'd be really grateful. 

Thanks in advance 

Flugelhorn

I think Benenden is a discretionary service and if they consider that the diagnosis and management can be handled OK on the NHS then they won't pay. They tend to only pay out if there is a delay in diagnostics but X-rays for injuries can be obtained quickly and referrals to fracture clinics are no quicker in the private sector - I doubt they would cover injuries like this - though they may cover some physio at some point. 

sheramber

Benefit do medical diagnostics as well as other services. 

Did your mother explain she wanted surgical services not medical diagnosis. 

Benenden  do not cover all treatments. They explain that in their guide.

Check her paperwork for details of what surgical services they do cover. 

If you still think she should be covered then ask them to explain where in the paperwork it covers that exclusion.