Bupa won't pay surgeon's full fees

tyllwyd · 18 November 2012 at 1:45PM

My OH recently had surgery under the BUPA cover provided through his employer. He was told that there would be an excess to pay, and that there would be extra to pay to the anethetist, but that the full cost of the actual surgery would be covered by the scheme.

We've now had a letter through from BUPA telling us that the surgeon has invoiced for (approx) £500 but they have only paid £300 and that we aren't liable to pay the difference of £200. My OH is due to see his surgeon for the post-op follow up, and he isn't quite sure where he stands. We would be quite willing to accept that the operation was probably more difficult than originally anticipated (due to complications from previous surgery) and pay the £200, but we aren't sure whether to expect the surgeon to raise it with us or whether we should just accept what BUPA has said and leave them to argue it out between themselves. Has anyone else been in this position?

NeverEnough · 18 November 2012 at 1:58PM

It depends on your contract with BUPA - if there is an excess mentioned, you would need to pay that, (is that not part of the £200??) and also anaesthetist costs if that again is mentioned as not being covered. Your liability under the contract should end there, unless there is another clause stating you will be liable for additional costs invoiced by providers not included in the excess or anesthetist fees - BUPA has said this is not the case, so just pay what you are contractually obliged to pay.

Surgeons / other doctors working in BUPA hospitals sign up to charge fees within a certain scale - if this surgeon is charging outside of what BUPA allows, then the charge will not be payable. Either way, seems BUPA is dealing with it, just liaise with their accounts dept. and find out what you are contractually required to pay. Hope OH is well soon.

Wutang_2 · 18 November 2012 at 2:00PM

tyllwyd wrote: »

My OH recently had surgery under the BUPA cover provided through his employer. He was told that there would be an excess to pay, and that there would be extra to pay to the anethetist, but that the full cost of the actual surgery would be covered by the scheme.

We've now had a letter through from BUPA telling us that the surgeon has invoiced for (approx) £500 but they have only paid £300 and that we aren't liable to pay the difference of £200. My OH is due to see his surgeon for the post-op follow up, and he isn't quite sure where he stands. We would be quite willing to accept that the operation was probably more difficult than originally anticipated (due to complications from previous surgery) and pay the £200, but we aren't sure whether to expect the surgeon to raise it with us or whether we should just accept what BUPA has said and leave them to argue it out between themselves. Has anyone else been in this position?

This is the ongoing problem with Bupa (with many Bupa customers who have to claim), they are a truly awful company.:mad:

There is little you can do apart from ask surgeon to reduce cost..

Even if you have Bupa as a work benefit, (as you have spotted) it can still cost you. Leave them and get a proper medical insurance plan once this procedure is finished.

There are so many Bupa customers that are brainwashed (by the name) and also, frighteningly, lots of Bupa customers refusing to accept that they are an appalling outfit.:eek:

Wutang_2 · 18 November 2012 at 2:01PM

NeverEnough wrote: »

Your liability under the contract should end there

Sorry but this sounds like guesswork:T

prowla · 18 November 2012 at 2:11PM

I once got chased by debt collectors for a portion of a bill for dental work that BUPA said I owed them; me and the specialist both saying it was all-inclusive and that I had paid in full didn't seem to be good enough for them.

It took a long time for it to be resolved.

magpiecottage · 18 November 2012 at 3:14PM

BUPA is an insurer and is covered by the Financial Ombudsman Service.

If you have a dispute with them make a complaint to BUPA. If that does not produce a satisfactory outcome, complain the FOS.

NeverEnough · 18 November 2012 at 8:15PM

Wutang wrote: »

Sorry but this sounds like guesswork:T

It's not actually - if you have an agreement for a service, it depends on the terms of your contract as to what you need to pay. OP has already stated there is an "excess" - so the £200 must include at least some of the said excess. Plus surgeons working from BUPA hospitals have an upper fee limit they can charge.

Are you always offensive and rude ? Nice to hide behind your keyboard sniggering in your anonymity?? Pathetic.

On_My_Lonesome · 18 November 2012 at 8:24PM

When you call BUPA to pre-authorise they will tell you that if the surgeon/anaesthetist etc charge over BUPA agreed fees then you will be liable for this extra, did they not tell you that when you called to pre-authorise? If not worth getting them to listen to the call to confirm this and that should help your cause.

I called to pre-authorise last week and it was very clearly explained, I already knew my surgoen always charges within defined limits though.

Wutang_2 · 18 November 2012 at 8:41PM

On_My_Lonesome wrote: »

When you call BUPA to pre-authorise they will tell you that if the surgeon/anaesthetist etc charge over BUPA agreed fees then you will be liable for this extra, did they not tell you that when you called to pre-authorise? If not worth getting them to listen to the call to confirm this and that should help your cause.

I called to pre-authorise last week and it was very clearly explained, I already knew my surgoen always charges within defined limits though.

Lonesome: valid point, only very few consultants work with Bupa currently which has caused a rift amongst consultants themselves. If Bupa got with the times then this shortfall wouldn't happen. Trouble is, they're refusing to.

tyllwyd · 18 November 2012 at 11:01PM

We are due to pay an excess of £50 to Bupa - this is a separate issue and that's not a problem. It was made quite clear that anethesist would charge more than BUPA would pay and we would be liable for the difference - again, we understood that and it is not a problem. The problem is that we did get the surgery pre-authorised and we were told it was fully covered. We dont understand why BUPA is not paying the full amount of the surgeon's fee, and why they are telling us that we are not liable for the £200 difference - and if we can expect the surgeon to chase us directly, considering that this was not agreed beforehand.

NeverEnough · 18 November 2012 at 11:05PM

Wutang wrote: »

Where was that 'offensive and rude'? If this insults you, life is going to be a struggle. Ironically I am now sniggering as you sound like you're making up your responses and you've use the word 'pathetic' without being sarcastic. Now go to bed. Pathetic :money:

Scuttle off into your hole and don't issue orders which I would never listen to, anyway. Obviously you didn't graduate from any charm school, that's for sure, you nasty little person.

Bupa won't pay surgeon's full fees

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