Bupa Not Paying Claim.....

[rolfefox]

I was recently denied payment by BUPA for a heart stent operation. They claimed a three-year-old cholesterol test which was 11 points over 200 proved a pre-existing condition. This does not even meet their own definition of pre-existing condition.

Has anybody else been denied payment for a similar situation or required a lawyer for payment?

[offset]

I was recently denied payment by BUPA for a heart stent operation. They claimed a three-year-old cholesterol test which was 11 points over 200 proved a pre-existing condition. This does not even meet their own definition of pre-existing condition.

Has anybody else been denied payment for a similar situation or required a lawyer for payment?

When I went for insurance my cholesterol was 204 but it was enough for them to exclude any heart problems from the cover

[Sheryl]

If the payment was denied solely on the basis of a prior cholesterol level, with no other evidence of pre-existing coronary artery disease, this is absurd and you should most definitiely appeal.

The challenge, of course, will be in figuring out how to do this. You need to speak with the "Financial Ombudsman Office" or Thia equivalent. Be very firm, stating that you wish to appeal a denied claim and insisting on being put through to the appropriate person.

Start by reading your policy and handbook, fine print included, to see if the process for appeal is described or contact information for an ombudsman provided.

If no luck in getting hold of an appropriate person -- or if they refuse to provide inf0 on how to appeal the claims denial -- you might try contacting the parent company in the UK:

The Customer Relations Department:

Phone: 0845 606 6726 Lines open 8:30am to 5:30pm Mondays to Fridays.

Fax: 01784 893175

Financial Ombudsman Service:

South Quay Plaza

183 Marsh Wall

London

E14 9SR

Tel: 0845 080 1800

Please let us know how this turns out, many of us (myself included!) have BUPA coverage and reports of this type are disturbing.

Assuming there are no details omitted from this story, your case is so solid that I would try to pursue it on your own first before resorting to a lawyer. If you do have to hire a lawyer, make sure it is one with experience in insurance claims.

[rolfefox]

If the payment was denied solely on the basis of a prior cholesterol level, with no other evidence of pre-existing coronary artery disease, this is absurd and you should most definitiely appeal.

The challenge, of course, will be in figuring out how to do this. You need to speak with the "Financial Ombudsman Office" or Thia equivalent. Be very firm, stating that you wish to appeal a denied claim and insisting on being put through to the appropriate person.

Start by reading your policy and handbook, fine print included, to see if the process for appeal is described or contact information for an ombudsman provided.

If no luck in getting hold of an appropriate person -- or if they refuse to provide inf0 on how to appeal the claims denial -- you might try contacting the parent company in the UK:

The Customer Relations Department:

Phone: 0845 606 6726 Lines open 8:30am to 5:30pm Mondays to Fridays.

Fax: 01784 893175

Financial Ombudsman Service:

South Quay Plaza

183 Marsh Wall

London

E14 9SR

Tel: 0845 080 1800

Please let us know how this turns out, many of us (myself included!) have BUPA coverage and reports of this type are disturbing.

Assuming there are no details omitted from this story, your case is so solid that I would try to pursue it on your own first before resorting to a lawyer. If you do have to hire a lawyer, make sure it is one with experience in insurance claims.

I very much apreciate your information and support..They did just say they would review the case,,,this was quite a surprise since it took over 2 month to deny. I will let you know the outcome...

[churchill]

Recently applied for Health Insurance - I am 50 in good health but I take medication for Cholesterol and a very low dose for high blood pressure and got this exclusion from the insurance co -

'I’m sorry for my late reply. According to your question, if the doctor who take care your case gives report that your heart problems base on Hypertension or Hyperlipidemia, insurance company will not pay for that. But if doctor report mention to something else not because of Hypertension or Hyperlipidemia , insurance company will pay out. Every time the underwriters need to refer to doctor report"

Although I would like to have health insurance , with these exclusions I don't see much point . The Dr is not going to make a false report to the insurance co just so you can claim .

[philo]

The Dr is not going to make a false report to the insurance co just so you can claim .

This might not be entirely true. BUPA has a clause that says they will not pay for anything related to alcholism, but I have been given an offer by a big private hospital to go into detox on a 'normal' medical diagnosis.

[madmitch]

Recently applied for Health Insurance - I am 50 in good health but I take medication for Cholesterol and a very low dose for high blood pressure and got this exclusion from the insurance co -

'I’m sorry for my late reply. According to your question, if the doctor who take care your case gives report that your heart problems base on Hypertension or Hyperlipidemia, insurance company will not pay for that. But if doctor report mention to something else not because of Hypertension or Hyperlipidemia , insurance company will pay out. Every time the underwriters need to refer to doctor report"

Although I would like to have health insurance , with these exclusions I don't see much point . The Dr is not going to make a false report to the insurance co just so you can claim .

Try another company.

It is difficult to get underwriters to be a little more flexible in Thailand; if it is a problem, they exclude it. You may get a company that will cover it at an increased premium and/or impose a co-insurance.

To the OP, I replied on another thread but basically agree with Sheryl.

[Heng]

Yeah, they wouldn't pay for my dad's hernia surgery (only about 40,000 Baht) because they said it was a pre-existing condition. Arbitrary decision they said. Luckily we have AIA as well. In that case, even the blood-from-a-stone gov't plan paid up, as I recall.