Insurance company issues

[Nubes]

Hi everyone. I'm new to this so I've no idea whether anyone can advise me. I've recently been told I need bypass surgery and it's apparently quite urgent. I've got private health insurance (since 2021, never used), but when I contacted them they said that because I've been on statins since 2015 and am also on amlodipine to moderate blood pressure that I am probably excluded from claiming on grounds of pre-existing conditions. My heart specialist disagrees, saying that the meds I've been on are more about prevention of serious conditions rather than treatment. Has anyone else successfully argued this? He said he'll provide me with a letter to this effect, but I don't want to bother him unnecessarily.

[Lowerfield_no_more]

Either you are excluded from your insurers meeting the costs of a claim by the terms of your contract or you aren't. It can't be 'probably'. Sounds like the insurer is trying to put you off, given there are £££s at stake. So I suggest you read your policy to find out where you stand. And then, assuming there's nothing in the small print which means they can decline to pay, I suggest you ask your cardiologist to write a letter which confirms your position regarding 'pre-existing conditions' vs. your current situation, since he is sympathetic, and then send that to your insurance provider under cover of your own letter which asks them to confirm that they will pay for your treatment under your insurance cover. (Although you may have to pay for the cardiologist's letter). And I would send the letter recorded delivery so there is no excuse it ' got lost in the post'.

[Nubes in reply to Lowerfield_no_more]

Thanks very much, much appreciated.

[MustyK in reply to Lowerfield_no_more]

Totally agree with the above. This should get them to change their position.

[Swimmerb]

Get the letter from your cardiologist.My insurers would not pay for me to see a cardiologist as I had seen my GP once for palpitations which were nothing to do with my present problems.

It took my GP to complete a 7 page form on which he stated this in no uncertain terms!

I was telephoned the next day to say I was covered.

[Thesnowman51]

I would agree with the other answers, I think the insurer is trying it on. Amlodopine is for high BP and 50% of the country are on statins for raised cholesterol, neither define your situation as having heart failure. They are trying to put you off, as a bypass op costs about £50,000. Continue the claim. Good luck

[Hanibil]

Hi may I ask the name of this company as I have private health insurance and you post really concerns me. Thank you

[Nubes in reply to Hanibil]

Aviva

[Lawburd]

This does not surprise me I’m afraid. When I was looking at buying health insurance I read the small print (lawyer for 30+ years😏) and realised that most life insurance cos could refuse to pay out on the basis of either ‘pre-existing’ or ‘chronic’ conditions exclusions in their terms. I queried this with the broker and he checked with BUPA - who he’d recommended to us- and confirmed this would be their attitude with anyone on statin/high BP tabs. Most insurers are the same but I believe Exeter will still cover provided no incidents within the previous 2 years.

[Bobkins99]

No, but it does highlight the con that is private medical insurance. God preserve us if they continue to privatise the NHS and go the American route

[Mitchum]

DO bother him! He's offered the information to you so take it to the insurers.

[Lexi72]

hi insurers have for some time now had a higher level duty under FCA rule book to treat customers fairly so they cannot always rely on duty of good faith and the fact that most policies require you disclose all pre-existing conditions under the policy wording to escape liability under their policies . That said you would normally disclose any meds you are on. Not sure what your policy says On the basis of what your cardiologist has told If they refuse cover and depending on the policy terms you may be able to challenge any refusal under the insurers dispute resolution process on the basis this is not fair and ultimately escalate all the way up to the financial ombudsman scheme. Definitely worth a go with the cardiologist’s letter and escalate the complaint if they refuse. Not sure if it will work but nothing ventured nothing gained. However you may well be focussing on other things at the moment .

[Nubes in reply to Lexi72]

Thanks. Very useful information

[Alicant]

get another company…if they argue BEFORE a you make a claim no way will they pay out when you do!

[PowerFly]

Do you really want to go to a private hospital for major heart surgery? Check out IPlayer for the Panorama programme: NHS Patients Going Private. If it’s urgent then NHS wait time shouldn’t be too long.

[Nubes]

9 months according to the surgeon!