Author: Dot Piper

Private medical insurance policies are becoming increasingly used tools. NHS waiting lists just don’t fit in with many people’s busy lifestyles and a convenient appointment and treatment may be top on your priority list, should you or your family fall ill.

As with all insurance products, private medical policies vary in their terms and are specific about what they do and don’t cover. For instance, one of the most well-known insurers, Bupa, will only cover you for “experimental” medical treatment where that procedure is part of a valid medical trial or study. Another well known insurer, Norwich Union Healthcare is only happy to cover treatment that is classed as standard practice in the UK.

It could be that your private care doctor feels that the best treatment for you would be one of the newer ones, as opposed to an older, standard, procedure. Obviously you’d probably be happy to accept the doctor’s recommendations. You could then be in the situation where your insurance company would not cover the cost of this treatment.

Where these problems have occurred, patients have submitted complaints to the Financial Ombudsman Service, otherwise known as the FOS. As a result of this, the FOS has, in some cases, ruled against the insurers and it has been possible to include some of the newer treatments in practice. Laser treatment has replaced larynx surgery in some cases, and key-hole, rather than open-wound, bladder treatment can now also be covered.

Although used in the USA for five years as standard practice, there was a new form of varicose vein surgery which insurers in the UK were declining to pay out on, until the FOS decision was made to accept the treatment.

It appears that the FOS can only overturn the decision of the insurer regarding experimental treatments where such treatments are not specifically excluded in the policy. If the policy is specific about exclusion of these treatments, the ombudsman will not be able to help.

The FOS says “If the policyholder has been advised by his or her treating physician that, in their particular circumstances, they should have a newer treatment instead of an established procedure, our general view would be that it could be unfair for the firm to turn down the claim entirely.” However, they also point out that, by ruling against the insurers, it doesn’t follow that they endorse specific treatments.

The response of the insurers to these rulings seems to be that they may well be re-considering their position in regard to experimental treatments and how they deal with them. Norwich Union have stated that a review of their policies is in the pipeline in view of the rulings of the FOS. Bupa are concerned that their clients may be claiming for treatments not yet tested in the UK.

WPA, another medical insurance provider, have stated that if a doctor has recommended a specific course of experimental treatment, for which there are grounds to prove why that treatment is better than any other, then they will cover this.

It appears that things are falling into place and necessary changes are taking place regarding the experimental treatment scenario. If you’re about to take out this valuable insurance, it’s as well to keep all these issues in mind. By logging on to the internet and finding a broker who will compare what’s on offer from the many policies available in the medical insurance market, you’ll be able to find the right policy for you and your family. At the right price too.

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