Private birth -advice or experience in dealing with AXA PPP needed

[lisao2]

Hi, I have been given the go ahead by AXA PPP to cover a private c section who have said they will reimburse costs up to a level. The level is rubbish though, they will only pay a specialist fee of upto £600 for a consultant to perform the C section!!! As far as I understand the average consultant fee for this is around £3k plus hospital costs. AXA PPP say that £600 figure is based on a national country average. Not sure which country they are talking about but this is definitely not a UK average?..
This seems very unfair and unethical, any advice on how to tackle this stressful issue or on how to get AXA to see sense and realise how unfair this policy is would be grateful appreciated!

[Chynah]

BUPA are the same. Really don't think you'll get anywhere but good luck anyway

[ajmama]

I know its a horrible situation but true im afraid. If you can get AXA to see sense then you will do a lot better than all of us on here who have had the same battle. If you are going down the private route you will only be covered for the bare minimum. Im having dc2 at the Portland and my consultants fees are £7k and the hospital bill around £12k. I had ds 6 years ago and insurance companies were a lot more lenient then but still only covered the minimum, as I was going private anyway it wasnt an issue and the payout was a bonus. Hospital and consultants fees have really whacked up since then and levels of insurance cover has gone down.
I know its frustrating and I am so sorry not to be the bearer of good news. Im sure others who have been in the same boat will be along later. x

[cardamomginger]

I don't understand this at all. Unfortuantely, I have had to make a number of claims on my insurance (with AXA PPP) for various procedures, including different surgeries. Very occasionally there is a difference between the consultants' fees and the amount AXA PPP is prepared to pay. But it's in the order of 50-100. Theatre costs and hospital accommodation has always been paid in full. As have pre and post operative consultations. Why are c-sections so different?

[ajmama]

The argument is that c sections are not deemed medically necessary and are the result of a lifestyle choice not an illness. Also private obstetric care is extremely expensive. When dealing with them it is like hitting a brick wall and I think they hope you will just get fed up and go away.

[Chynah]

It's not just Csections - most operations are only covered to a minimum and you have to top up yourself.

[QTPie]

Ha ha about C Sections not being medically necessarily.... I know that footling breech can be delivered vaginally, but I wouldn't have fancied it! Certainly a few other more pressing medical reasons too.... It is a bit like saying "having varicose veins treated" or a "hip replaced" is not medically necessary... There is obviously some loophole that they are exploiting....it isn't right, but not sure there is much we can do about it :(

I had an unpleasant experience with Bupa: measly £3.5k (out of £15k bill), but the worst was the 4.5 months it took me to get them to pay up (despite 3 weeks notice before the operation. Wasn't sure if it was huge incompetence or them trying to avoid paying. Left a very sour taste in my mouth. We immediately left Bupa.

You might want to "shop around": certainly Bupa seem to cover significantly more at the Portland (various costs + 4 nights inpatirnt?), than they would for me at John and Lizzies.... Axa PPP MAY be similar. This may or may not effect your choice of hospital, but it is worth considering.

Good luck
QT

[PenguinArmy]

Haven't consultant fees just really jumped recently due to extra insurance costs.

Costs seem to be a tenth of what I heard about here in the US, but I guess that's the power (and one of the few good things) about insurance companies in that they have a lot of bargaining power in determining prices

[cardamomginger]

ajmama Surely each ELCS is considered on an individual basis and if the insurance company did not consider it to be medically necessary, then they would not pay for ANY of it. I can't imagine that there are degrees of medical necessity where if you or your DC would pretty much die if you attempted VB then they;d pay up, but if you "only" wanted to avoid a real risk of repeated perineal damage and likely double incontinence, they pay only a small amount.
Yes, private obs care is expensive. But any private healthcare is expensive. Just thinking about my daughter's consultant at Great Ormond Street, who cheerfully charges around 250 for a 20 minute appointment. And the insurance company pays it.
Chynah - but that's just my point - all my previous 4 inpatient surgeries have been covered more or less in full, except the occasional 50-100 quid here or there (mostly for anaesthetists' fees, rather than surgeons'), so why is C section different?

[ajmama]

C, I am just repeating what the insurance company told me. I dont work for them and my DS and myself would have been in very hot water if I were to have attempted a VB. I dont make the rules and they stink. If you wanted to just avoid a VB they would not pay out a penny as it is not considered an illness. Take it up with the insurance companies, none of us are lying and I guarantee you will get the same response that we did.
Penguin you are right Obstetricians insurance costs have whacked up.

[cardamomginger]

ajmama - sorry - wasn't implying that that was what you believed, just put your username so it was clear which comment that bit of my comment was about. Ditto when I used chynah's name. And I'm certainly not suggesting that anyone here is lying. I joined in the conversation because I just genuinely do not understand why c section seems to be different than other medical procedures. My questions were supposed to be rhetorical and I wasn't quizzing any one individual.

[QTPie]

Cardamomginger.... Because - through some loophole or another - "they can"....

It does stink to high heaven.... :(

[silverangel]

I'm having a section - identical twins, severe TTTS, and I'm with AXA, they will only cover 'medically neccessary' sections and apparently my reasons aren't medical enough to warrant them to cover it

[BagofHolly]

AXA PPP are utterly crap. They provide our cover through my husband's firm and I had battle after battle with them. Initially I was told I wouldn't get any cover at all because we'd had IVF. they backed down. Then they said they would cover my CS (twins, mentioned specifically in the policy document as reason for ELCS) but not the babies as they are the product of assisted conception and are more likely to have "defects'!!!
Then they said they'd provide cover to £300 plus hospital fees as this figure represented a "median" figure for the cost of CS. I asked for the names of consultants they had paid in the past, who did elcs for £300 and they duly handed over names, including Tariq Miskry. I called them all and not one was less than £3000. The woman I dealt with was deluded and kept saying "well that can't be right." But it is, of course.
In the end, my husband's company settled the entire account and AXAPPP just did the admin - it's a "trustee" policy. I'd urge anyone considering AXA to go elsewhere. They were awful.

[BagofHolly]

Sorry, got ranty. I'd ask for a formal response from the medical department as to how they've reached this figure and ask them to find YOU a doctor who'll do it within their guideline price. They won't be able to. Then go to the Ombudsman. I couldn't do this as ours was a trustee policy but you can. They've lied saying that they provide cover she they actually only cover a donation of between 10-20%.

[BagofHolly]

BTW it's nothing to do with "lifestyle" and I'd ask for the name of the ignoramus who said this. My consultant's secretary said they take the price from the cost of a hysterectomy because it takes a similar time in theatre with a similar sized team. The additional cost is the consultant's liability insurance.

[lisao2]

Thank you so much for your advice and experience. Am going to fight them on this. I think their behaviour is unethical. Just had a conversation with one of their 'advisors' who was unable to give me any names of consultants who has performed a c-section for £600. I then asked if she could confirm that C+W was covered and they are unable to do this unless you can confirm your consultant. How can you confirm a consultant at C+W if you dont know if C+W is covered in the policy!!!!! Crazy, asked to speak to someone 'senior' but am sure it will be anotherfrustrating conversation. Im going to start putting it in writing now. They have agreed that my c section is medically necessary but are now trying to wangle out of the committment. At the end of the day we are the client and we have a private insurance cover for a reason and it is either a benefit of a job or something we pay for. They act as if we are on the take rather than helping us claim what is rightful ours. They should be offering help to navigate the system not trying and cut us dead and hope we go away.

Sorry for the HUGE rant but im so incensed at this behaviour. Not sure if this will get me anywhere but will try and my company is the first port of call before the ombnusman. Will keep you updated!!!!!

[cardamomginger]

Good for you and good luck! Let us know how you get on. xx

[squiby2004]

BagOfHolly I had my DD with Tariq at the Lindo wing and his fees were £4.5k in 2004 so I would have thought quite a bit more by now. We got £1800 of his fees paid as we were under his care anyway so knew we would have had an extra bill but they settles the 5 night hospital bill full so all in all I only paid £1800 for a bill that totaled well over 10k!

[QTPie]

Thanks for the update, Lisa. Can't say that am surprised! To be perfectly honest - from my and others experiences - I honestly think that they prey on pregnant women and new mothers having so much on their plates that the give up.... It is awful!

Tbh, I am glad that I have not been the only one he has had an awful experience over this: it confirms that I wasn't just an unlucky case....

Please please please keep us updated. And good luck with it all x

[cardamomginger]

Of course if they claim that 600 or 300 or whatever is the "median figure" for c-section fees in the UK, then this implies there are consultants who do it for less than that sum . Be interested to see that list.....

[AnaGon]

lisao2 I know it's been years since anybody's commented on this thread, but have you had any luck with AXA and the ombudsman? It's 2016 and they would still cover ONLY £600 in consultant fees for an elective CS with grade 4 PP. I'm only 22 weeks and still hoping for a miracle my placenta previa will move so wondering if I should take them on now.