To be or not to be!

Posted by Proactive Medical & Life on Friday, August 28, 2015

To be or not to be... covered at the right hospital?  Twice in one week, we've had clients who have been caught out by a strange anomaly with some of the health insurance companies.  The problem is that if a child needs a specialist operation which can only be carried out at a specific hospital, the insurance company are refusing to cover the treatment because the hospital is not on the client's chosen list. 

So where does the fault lie? And whom with? The initial consultation was a with an approved specialist at an approved hospital (on their list) but the consultant only operates out of THE WRONG PLACE.  It can really leave a sour taste for a client, when dealing with the this part of the policy.

1.  The insurer says that its not their policy to cover that hospital.

2.  The consultant only uses that hospital to carry out pediatric treatment, and makes the situation worse for the client, by putting them in a predicament.

3.  The client has a choice to use that hospital, but has a major shortfall, losing out again in the confidence of the policy that they are paying for.

4.  The broker gets involved to argue the case that the client did not believe the client was doing the wrong thing initially by seeing that consultant on that hospital list which the client has access too.

5.  The client has to then make a change of consultant so that the right hospital is used in the end for the treatment, causing further frustration, time wastage and more cost for all parties.

So, BUPA have offered in their policy BUPA BY YOU that if  pediatric (children under 16) treatment needs to be carried out in a hospital that is not on the clients chosen list, the treatment will still be covered regardless.  This is a great touch by BUPA and well thought out.  However for clients that live in Greater London, and use hospitals local to them, but where consultants only operate on children in Central London, makes it a very difficult and frustrating situation.

I think all insurers that have a tiered hospital list should look more closely at this problem, which I am sure will become more problematic in the future.  We are a service related industry and should really be thinking about the welfare of those we are protecting so that life is easier for all involved.  It makes for a happier life :-)

Tags: specialists  consultants  hospital lists   

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