Private Medical Treatment

[Frank Manning]

I wonder if anyone has experience of this scenario. The insurance we had required us to always consult an NHS GP before approaching them. In August my wife began to experience serious bloating and digestive problems including bringing up lots of wind after eating. This followed a meal at Harry Ramsdens in connection with a visit with friends to the Swanage railway, very fatty. Eventually we got to see one of our GPs a lady. She dismissed any connection to fatty foods, and suggested ovarian cancer (imagine the effect this diagnosis had), for which an immediate specialist appointment was required, and no there was little hope of such an appointment quickly via the NHS, and did we have medical insurance. We gave a tentative yes to that but went home and contacted our insurer who suggested that they would be prepared to help. Within two days and before we could arrange anything we had a telephone call from a private specialist arranging an appointment, and naturally we thought it would be with a gynaecologist. Imagine our surprise to find that it was in fact a gastroenterologist. The Insurer refused to pay and we have had to pay £700 for two consultations and a scan.

Happily after the first consultation and before the scan (which showed nothing) he suggested a biliary stone, within hours my wife had a spasm and then the whole thing miraculously seems to have gone away. Now I am of the opinion that it was money well spent for peace of mind, but questions remain about the original diagnosis and the motive for sending her to a gastroenterologist (very nice man and highly skilled though he was). She had her gall bladder removed about 9 years ago.

We have cancelled our health insurance.

[GillD46]

That is bizarre from start to finish. I don’t understand her saying there would be a lengthy wait for an appointment for a suspected cancer diagnosis, and most GPs can refer for urgent scans. As to why a Gastroenterologist, well her symptoms would support that, though not the provisional diagnosis that was given.

Glad to read she is ok.

[Stephen]

Half the time I think some of these GP's don't know they're ar*se from they're elbow.

[david63]

Half the time I think some of these GP's don't know they're ar*se from they're elbow.

Which is quite worrying when they have been to Medical School for several years!

[qbman1]

Half the time I think some of these GP's don't know they're ar*se from they're elbow.

I wondered why they prescribed a suppository for my sore arm !

Seriously, though, it sounds to me like the GP was at fault, not only with a peculiar diagnosis, but also with the referral

Even so, you can't put a price on the relief to know all is well in your case at least, Frank

[Frank Manning]

I never like to apportion blame to a GP. Symptoms can be very confusing and when you think how complex human physiology is it is amazing that they can tell anything for sure. It seems that blood tests and scans are the key indicators these days. The strange thing is that she booked a gastroenterologist after virtually insisting that this was serious and was likely ovarian cancer. She initially said there is no way it could be associated with food, despite prescribing Buscopan an anti spasmodic. The letter from the specialist to the GP was effusive in its thanks for referring her, which also made us a bit suspicious. As I said before the specialist was excellent.

It was a heck of a worry for about two months. I am now rather cynical about medical insurance, after paying for ages and having nothing, because they treated us like potential fraudsters when we asked if they would pay for the consultations and the scan. The tone of their letter and telephone manner belied the wonderful care promised in their glossy brochure.

Perhaps we will save the premiums towards a cruise.

[Stephen]

I never like to apportion blame to a GP. Symptoms can be very confusing and when you think how complex human physiology is it is amazing that they can tell anything for sure. It seems that blood tests and scans are the key indicators these days. The strange thing is that she booked a gastroenterologist after virtually insisting that this was serious and was likely ovarian cancer. She initially said there is no way it could be associated with food, despite prescribing Buscopan an anti spasmodic. The letter from the specialist to the GP was effusive in its thanks for referring her, which also made us a bit suspicious. As I said before the specialist was excellent.

It was a heck of a worry for about two months. I am now rather cynical about medical insurance, after paying for ages and having nothing, because they treated us like potential fraudsters when we asked if they would pay for the consultations and the scan. The tone of their letter and telephone manner belied the wonderful care promised in their glossy brochure.

Perhaps we will save the premiums towards a cruise.

I know how you both must have felt Frank. When I was diagnosed a few years back with a suposidly small tumour in part of my plumbing by a consultant it turned out under surgical investigation by another consultant that whatever it was had disappeared. So much for correct diagnosis and scaring the bejeebers out of us.

[Manoverboard]

Our insurer will pay if one's GP refers the patient to an approved specialist. The chosen specialist has to be ' registered ' with the Insurer. If not they will not pay so always check in the first instance. Another factor to note is that scans / tests are not paid for for any condition that was diagnosed more than 10 years ago to the day.

[Frank Manning]

The problem for us was that our GP didn't wait for any formalities with the insurer. It was GP visit on Wednesday, appointment confirmation Friday, and all this against a background of her dire and Sue says dramatic warnings about ovarian cancer. The hospital and the man are on their approved list. However as I said in my letter to the insurer, there is no point in paying premiums if, when there is supposed urgency they are going to make us and our surgery jump through hoops to prove that it is necessary, only to say that they will not pay up. It is just giving money away for nothing.

As a child of the Atlee government I suppose one might say I have been spoiled. Cushioned by the welfare state. The truth is that I paid them my NI for 47 years and cost them very little, and although I don't expect special treatment personally, I am sold on the idea that the state has a major place in education, health and welfare. It is the only protection the ordinary citizen has.

But that is too political, I just wanted to tell our experience and hear what people think.

[Mrsvalb]

If we get a referral from GP, one phone call to insurers informing them of condition, who you are being referred to and where.

They then check that the consultant is on their approved list and they then authorise the consultation and any tests that the consultant wants to do followed by a second consultation to get the results. This is all authorised on the one phone call. Once we have the results another phone call to update insurers and they will authorise treatment.

We have never had a problem in getting authorisation for anything. Our scans/tests will continue until 10years after the last treatment for that particular condition.

I think that I would be inclined to challenge the decision not to pay the claim.

Val

[Frank Manning]

I think it is too late for that Val. I left it one month before I wrote again to cancel and stop the direct debit. The whole tone of their telephone and written communications was to say the least one of "tough luck, its our decision and the decision is no". Somewhat different from the wording in their glossy brochure. A lesson learned, but at least my wife is well, and that is far more important than money.

[towny44]

Your experience is one more nail in the private health insurance scam. We decided after a few years of paying ourselves, once my works health care finished, that this was quite likely to be wasted money, so we decided to put the equivalent into a regular saver plan and use this if and when needed. Not that we do slavishly follow this policy, it just gets put into the general cruise fund and we will have to raid our savings if ever private treatment is ever needed.

[Manoverboard]

Your experience is one more nail in the private health insurance scam. We decided after a few years of paying ourselves, once my works health care finished, that this was quite likely to be wasted money, so we decided to put the equivalent into a regular saver plan and use this if and when needed. Not that we do slavishly follow this policy, it just gets put into the general cruise fund and we will have to raid our savings if ever private treatment is ever needed.

It isn't a scam but you do have to abide by the rules n regs ... no exceptions as laid out in the joining bumph.

[towny44]

Your experience is one more nail in the private health insurance scam. We decided after a few years of paying ourselves, once my works health care finished, that this was quite likely to be wasted money, so we decided to put the equivalent into a regular saver plan and use this if and when needed. Not that we do slavishly follow this policy, it just gets put into the general cruise fund and we will have to raid our savings if ever private treatment is ever needed.

It isn't a scam but you do have to abide by the rules n regs ... no exceptions as laid out in the joining bumph.

I was really meaning scam as in waste of money especially for the retired elderly, who generally have lots of time to wait for the NHS to creak and groan its way to attending to our needs and where, if the need is urgent as in cancer, they tend to move as fast as the private sector anyway.
I can understand the benefits for working age people where even for non urgent care choosing a time and location of your choice is important, and this is why companies offer this as a perk, especially for senior staff.
But we did the cost benefit analysis and decided it was not something we needed now, and that the benefit would continue to shrink further as we grew older.