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private hospital not informing patient gone way over insurance limit
I had an op in a private hospital last year and thought I was covered. The hospital needed to do an extra procedure and did not let me know the costs involved and went way over the limit set by my insurer.
at the time I asked the staff if i could be moved to an NHS hospital as was so far away from home to recover but this never came about. I was told by nursing staff that if their was an issue with the cover that the hospital would inform me but never heard anything so assumed it was ok as was too ill to pursue the matter anyway.
now I have a bill for £14 000. which I don't have the cash to pay and would take years to pay off if I could get a reasonable loan. what to do as I don't feel responsible for this but am now going to be persued by a debt management company and will get a bad credit rating.
Re: private hospital not informing patient gone way over insurance limit
no as that would give away to much information. I really thought that I would have been informed about such an excess at some point before it got so big.
Re: private hospital not informing patient gone way over insurance limit
Did you not check with the insurance company 1st? They would have been able to tell you your limit and how much you had claimed on your policy, Did you ring your insurance before each treatment was carried out? When i claimed through mine i had to call them before each visit so that they could authorise the claim! I made 10 visits in total and i know it seems like a chew on calling them all the time but it also gives you peace of mind so that the unexpected bill doesnt come through.
Re: private hospital not informing patient gone way over insurance limit
yes i did check with them and they gave me the limit but it was the hospital who did not tell me that they were going way over the limit and failed to keep me up to date.
Re: private hospital not informing patient gone way over insurance limit
It is difficult to advise without knowing what procedure you contracted for and what additional work was done. It sounds like something may have gone wrong and extra surgery needed given the amount concerned.
Re: private hospital not informing patient gone way over insurance limit
if they were informed by the hospital of the extra treatment and then notified the insurance company of what the hospital needed to do then surely the insurance company would of advised that the procedure would take the OP over the agreed cover limit and they wouldnt auth the treatment?
Re: private hospital not informing patient gone way over insurance limit
it also sounds like you might have one of the following policies:
Are there any catches I should watch out for?
Unfortunately, yes. It is important to be aware that certain insurance providers restrict the amount they will pay for treatment by operating a specialist fee schedule system. The problems this creates were highlighted by BBC's Watchdog programme and what this means is that the actual cost of your treatment could cost more than the limit the insurance company places on it. For example, if you were to undergo a hip replacement operation the actual cost could be £6500 whereas the fee schedule limit may be set at £5000. This would leave a £1500 shortfall which would have to be paid from your own pocket.
The companies operating specialist fee schedules are Norwich Union, PPP, Royal & SunAlliance, BUPA, WPA and BCWA.
Re: private hospital not informing patient gone way over insurance limit
i m not disputing any proceedures carried out its the fact that i could not get any information that their was a problem at the time and my requests to be moved to a public hospital got me knowwhere while i was being assured that everything was ok.
Re: private hospital not informing patient gone way over insurance limit
No offence intended moo cow but why should you be moved to an NHS hospital to pick up the pieces - you chose to go private and the onus was on you to ensure your insurance was sufficient.
Re: private hospital not informing patient gone way over insurance limit
I can't offer any advice in this case but I think moo cow's point is that they were in hospital having one procedure and in the process of that, a further procedure became medically necessary... now obviously in ideal circumstances one would contact the insurance company to make sure this further procedure would be covered, but when you're in hospital at the time and are told you need this procedure performed... is it reasonable to expect someone in that situation to be contacting insurance companies etc? It's difficult to assess moo cow, in that we don't know what procedures you had done and how ill etc you were but I can understand your point of view that you were told by the hospital that you needed this procedure and that you feel that if it was outside the scope and the fee coverage of your insurance you should have been made aware of that, however I'm not knowledgable enough to advise on the legal implications of that...
Does anyone have any knowledge in this area? Are private hospitals required to be aware of patients' insurance status and to warn them/inform them if proposed treatment will cost more than their cover allows?
Re: private hospital not informing patient gone way over insurance limit
I would be surprised if a private health provider did not obtain a guarantee of payment (of any fees not covered by insurance) upon admission or prior to beginning treatment. The potential need for the additional surgical procedure should have been covered during the consent procedure. Whether this should have been covered by insurance is dependent upon the policy wording; it is for the patient to ensure that their cover is sufficient for their needs.
Re: private hospital not informing patient gone way over insurance limit
I have to agree with SP here.
Most private hospitals have you sign an indemnity form taking reponsibility for all charges that fall due, The onus is on you to disclose to your insurer prior and they will explain the policy limitations. However, I do appreciate that the unexpected can occur. There are a multitude of policies (and benefits) out there, 'caveat emptor'.
My sympathies for the situation you find yourself in.
private hospital not informing patient gone way over insurance limit
company and will get a bad credit rating.
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