Take care on your private medical insurance

Thousands of people are being forced to pay unexpected hospital bills because of gaping holes in their medical insurance.

Campaigners are worried that policyholders expecting the best treatment are facing:

  1. Restrictions on which doctors and hospitals they can choose;
  2. Top-up bills of thousands of pounds;
  3. Being stuck with the same insurer because pre-existing medical conditions will not be covered elsewhere.

Bupa and Axa PPP have imposed strict limits on the amount many policies will pay out for surgeons and anaesthetists. They have their preferred network of hospitals to keep costs down.

The insurers say this is neces­sary to prevent doctors from overcharging — but some patients argue that cost limits are stopping them from access­ing the best treatment.

Almost six million people have private medical insurance and it can be expensive, especially for older people. A 30­-year-­old male can expect to pay around £57 a month for comprehensive medical insurance with Bupa, with a £100 excess.

This rises to almost £85 a month for a 50­year­old and £116 a month for a 60­year­old.

Derek Machin, chairman of the BMA Private Practice Committee, says: ‘Insurers make out they give customers total peace of mind, but in most cases customers will find there are exclusions and treatments they can’t get.’

‘Policies are restrictive, complex and difficult to compare. There needs to be clearer information for customers at the point of sale.’

The Financial Ombudsman Service, which settles disputes between consumers and insurers, upheld 48 pc of the 561 complaints it received about private medical insurance last year.

Many of the cases involved customers being asked to pay additional costs, such as a shortfall for an operation or out­ patient visits for which they were charged unexpectedly.

Another annoyance for people taking out medical insurance is that pre-­existing medical condi­tions are not covered, which deters people from switching providers. Axa PPP, for example, will generally not cover policyholders for two years (from when they take out the policy) for any condition they have even asked their GP for advice on in the previous five years.

However, these conditions will be covered if the policyholder does not seek further medical treatment for two years after the plan is taken out.

Bupa and Axa PPP say policy­ holders should contact their insurer before arranging treatment and no one will have to pay a shortfall if treated within their network. This all goes to prove do not buy a policy without proper independent financial advice