Health Insurance Claim and Excess

[Reavna]

Can anyone help me with this please?

 

My husband gets AXA private health insurance for himself, me and our 2 children as a benefit through his work.

 

We've claimed on it twice so far for our eldest daughter to have grommets inserted at our local Capio hospital as the wait at our local NHS hospital was quite long and her hearing was really bad and she was suffering with schooling, etc.

 

May 2006 she had her first op, had a check up 6 months later and everything was fine.

 

There's a £100 excess on the policy which we paid, everything else was covered by AXA. All done and dusted

 

During April/May 2007 I noticed that she was asking us to repeat ourselves a lot so I took her back for another hearing test. She failed the test abysmally and it was noticed that her grommets had come out and she was referred back to the ENT specialist at Capio and he decided to re-insert her grommets. This was done in June 2007, again on the AXA private health insurance.

 

As far as I could see this should have been an ongoing claim so we shouldn't have to pay the excess, but AXA said no, more than a year had passed and the claim had been closed so we had to pay the excess. Fair enough, we paid the excess and that was it.

 

She was booked to have her 6 month follow up check-up for the 15th December. We took her last Saturday and it was noticed that the grommets had come out again and that she needed them re-inserted. Op booked for the beginning of January.

 

I've phoned AXA to get the authorisation number that Capio need to confirm that AXA will cover the op and I've been told that I have to pay the £100 excess again.

 

Now, I swallowed it last time as more than a year had passed, and I can see the point they made then that the check-up gave her the all clear so the claim was closed, but this time the follow up didn't give her the all clear, and the fact that she's got to have the op again has come as a result from the follow-up. As she hadn't had the follow up the claim shouldn't have been closed. Also, it's only been 6ish months since the last op when they told me previously it was more than a year.

 

Any ideas please? I've had a look at the terms of the policy and I can see on there that a new claim will have to be started if more than a year has passed since the original treatment (July 2007 in this case) but nothing else that I can see.

 

I've spoken to the agent who sold the policy and from what he can understand he agrees with me but AXA are adamant.

 

Thanks!

[Guest Old_andrew2018]

any news

[blinky123]

I know this is an old post but I might as well reply just in case anyone else is wondering... If the claim/treatment spans your renewal date you would usually need to pay the excess again. For example, if your renewal date is in June and you go for treatment in April you would need to pay your £100 excess if you haven't already in that year. The policy would renew in June, then you go for another consultation in July you would need to pay the £100 excess again as a new benefit year has started. Although you are paying two excesses in the year, it really is only once per benefit year e.g June - June.