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Is private health insurance worth it?

Posted: Thu Nov 29, 2018 4:27pm
4 replies359 views7 members subscribed
pathwayscharlie

Posts: 1

Location: Jacarilla

Joined: 29 Nov 2018

I'd like to share my experience.

I have had private health care, here in Spain, for seven years, my cover level is to a high standard.

Fortunately my health has been very good, until recently.

A blood test result has meant a visit to a urologist and subsequently an MRI scan and biopsy.

My health plan covers for me both these procedures, however my urologist has recommended that I have a Multi parametric MRI scan, which I discover I'm not covered for, furthermore the biopsy is related to the scan and that is also is not covered by my insurance. I have now paid in excess of €2,200 for these treatments.

A letter to my insurance company asking for some financial assistance, ie the difference in costs between the scan that I have had and the scan that they were willing to pay also to pay the difference between the two biopsy's (which I'm told is very little difference). 

I have now heard that they are not interested in my claim and furthermore have threatened me with 'denunciation by their legal department should I tarnish their good reputation'. 

I now discover that I have cancer and been told that I will need to travel 100 kilometres per day for treatment due to the fact that my local hospital is too expensive!

What course is there for customer satisfaction?

Cheryl

Posted: Thu Nov 29, 2018 10:14pm

Cheryl

Legendary helpful member

Posts: 2973

3538 helpful points

Location: Albatera

Joined: 8 Jun 2017

Posted: Thu Nov 29, 2018 10:14pm

pathwayscharlie wrote on Thu Nov 29, 2018 4:27pm:

I'd like to share my experience.

I have had private health care, here in Spain, for seven years, my cover level is to a high standard.

Fortunately my health has been very good, until recently.

A blood test result has meant a visit to a urologist and subsequently an MRI scan and biopsy.

My health plan covers for me both these procedures, however my urologist has recommended that I have a Multi parametric MRI scan, which I discover I'm not covered for, furthermore the biopsy is related to the scan and that is also is not covered by my insurance. I have now paid in excess of €2,200 for these treatments.

A letter to my insurance company asking for some financial assistance, ie the difference in costs between the scan that I have had and the scan that they were willing to pay also to pay the difference between the two biopsy's (which I'm told is very little difference). 

I have now heard that they are not interested in my claim and furthermore have threatened me with 'denunciation by their legal department should I tarnish their good reputation'. 

I now discover that I have cancer and been told that I will need to travel 100 kilometres per day for treatment due to the fact that my local hospital is too expensive!

What course is there for customer satisfaction?

So sorry to hear of the problems you are having, and it always comes when we are at a low ebb.
I am no expert, so please make further enquiries of your own, however, I have worked in the health-related insurance world in the past so will offer what I can.

You mentioned your "Health Plan" and I take it this is just a figure of speech because, in the UK a Health Plan is very different to Private Medical Insurance and would only cover your first diagnostic consultation, to get you to see a specialist quickly, along with a very limited range of diagnostic tests such as blood tests and certain biopsies. The cover ends there, as it would be your choice to either go forward as a self funded private patient, or to go in the NHS queue. I don´t know if the same kind of thing is sold in Spain.
If it is Private Medical Insurance it will come with a very lengthy set of terms and conditions because however expensive the premiums, their risk is much more. There are often many choices as to what you want covered and are often modular, where you may opt for cancer cover, but exclude mental health, for example. Terms and conditions are strictly adhered to as they form part of the contract. It is not usual for Insurers to agree to pay anything towards other types of tests or treatment which are not covered because that could be argued that they have accepted liability for any other related tests or treatments which may follow.

 Insurers also tend to have agreements with certain hospitals who will guarantee certain rates to them. You would be amazed how much medical fees can inflate once the magic word Insurance is mentioned. The terms and conditions for which hospitals can be used will be detailed in the policy documents and will usually mention a certain travelling distance. It is not unusual for patients to travel many miles in the UK for both private and NHS specialist treatments.

If they are paying for everything as per the terms and conditions, I don´t think you have any options. Slating the company, if they are within the rules, could be taken very seriously and they may have been obliged to mention this to you.

Try contacting C.A.B es. I really understand your frustration and it is a very emotional and worrying time for you, but Insurance cannot be run on an emotional basis and therefore will sometimes appear cold and unaccommodating, it is the nature of the beast.

I think there are forum members who are in the Insurance industry who can hopefully guide you on up to date, Spanish policies but Citizens Advice will help.

Pacoboy

Posted: Fri Nov 30, 2018 12:46pm

Pacoboy

Helpful member

Posts: 478

317 helpful points

Location: Algorfa

Joined: 11 May 2018

Posted: Fri Nov 30, 2018 12:46pm

pathwayscharlie wrote on Thu Nov 29, 2018 4:27pm:

I'd like to share my experience.

I have had private health care, here in Spain, for seven years, my cover level is to a high standard.

Fortunately my health has been very good, until recently.

A blood test result has meant a visit to a urologist and subsequently an MRI scan and biopsy.

My health plan covers for me both these procedures, however my urologist has recommended that I have a Multi parametric MRI scan, which I discover I'm not covered for, furthermore the biopsy is related to the scan and that is also is not covered by my insurance. I have now paid in excess of €2,200 for these treatments.

A letter to my insurance company asking for some financial assistance, ie the difference in costs between the scan that I have had and the scan that they were willing to pay also to pay the difference between the two biopsy's (which I'm told is very little difference). 

I have now heard that they are not interested in my claim and furthermore have threatened me with 'denunciation by their legal department should I tarnish their good reputation'. 

I now discover that I have cancer and been told that I will need to travel 100 kilometres per day for treatment due to the fact that my local hospital is too expensive!

What course is there for customer satisfaction?

Sorry to hear of your problem it's not the first time I've heard this ,I don't know what age you are but we ha've returned to uk because getting old in spain can be a nightmare .I only been back a month when given a cat scan here that waited for a long time in spain so don't beleave everything you read about the NHS.

Had friends that had to travel by hospital bus from Quesada to benedorm for cancer treatment with other patents a day affair .

MaryM

Posted: Tue Dec 4, 2018 11:19am

MaryM

Helpful member

Posts: 144

65 helpful points

Location: Torrevieja

Joined: 3 Nov 2018

Posted: Tue Dec 4, 2018 11:19am

This post that was quoted has been deleted.

Doesn't the spanish equivalent of NHS cover this ? Only asking

MaryM

Posted: Tue Dec 4, 2018 5:29pm

MaryM

Helpful member

Posts: 144

65 helpful points

Location: Torrevieja

Joined: 3 Nov 2018

Posted: Tue Dec 4, 2018 5:29pm

Thanks for your reply ,,we are pensioners I forgot that it's only children and us benefit from the Spanish version of NHS

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