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Private Healthcare - Your periods may be used to invalidate your cover!! Beware ladies!(12 Posts)
Thanks a lot #BUPA!
If I'd known my honesty regarding my medical history was going to bite me on the arse, I'd have questioned your "questions" at the time.
Let me fill you in girls, so that you don't fail to realise that nature's monthly visit (always a happy occasion, I know we all agree) may also be deemed a "pre-existing symptom" of pretty much a whole host of conditions - thereby rendering your expensive policy useless!
After a routine blood test flagged me as anaemic, I asked for a referral to a (private) doctor who was recommended personally. Given that we had medical insurance with #BUPA - supposedly the gold standard in peace of mind, and taking into account how much I enjoy discussing all my bodily functions with strangers, this seemed a good plan.
Now, as you probably are aware, the most common strain of anaemia means you don't have enough red blood cells and one of the first places to look for problems when treating it is - of course - blood loss ie periods.
So off I go to a lovely gynaecologist who explains that I'm exhausted all the time because of the anaemia and did I have heavy periods? Well yes I suppose I do doctor. Ok no worries we can do something about that!
Further specific questioning alerted him to the additional fun possibility of endometriosis - good doctor as it turns out!
A laparoscopy revealed extensive endometriosis and he performed a Novasure ablation at the same time, as my kids are teenagers and it would help to restore my red blood cell count ASAP.
Now the fun bit! The afternoon before surgery (around 4.30pm) BUPA called to say, "sorry we're not paying!"
Come again?!! Am I not already stressed enough? I gave complete and full disclosure when my partner added me to his (10 year old) policy over a year ago and answered every question candidly. No one mentioned periods then, although I answered lots of questions about pregnancy, childbirth and previous gynae history.
Here's the thing girls - if you have periods that could be described as heavy - whether you have EVER mentioned it to your doctor - OR NOT (as in my case) you need to check the small print - because they can, and will, wriggle out of covering you!!!
For having periods!
Does this seem right ladies?
I have seldom (never ?) discussed my periods with anyone other than a vague "time of the month" reference, pain killers or hot water bottles do the talking for me. I had no idea what constitutes "heavy" periods ( I do now!)
In fact the medical profession is fairly subjective, stating on the NHS website that. "Most women know if their periods are a cause for concern." Please I beg you, ask yourself the "heavy period" diagnosis questions and then wonder how anyone would actually measure it - and who would want to! Periods are a naturally occurring curse, which we all put up with every month, with little thought of whether they are "normal."
I'm 47 so I've a bit of experience with periods by now and honestly if tampon/towel manufacturers make 6 different "sizes" from Very Light to Super Absorbent - stocked on shelves in every supermarket in every town across the globe, then I'm going to go out on a limb and say "heavy" is pretty normal for a lot of women and not cause to invalidate their healthcare.
So as I said, thanks a lot BUPA for failing to provide the peace of mind you promise in your cuddly caring adverts. I realise you are a business, but should honest women really be paying the price just for speaking the truth about Flo?
Surely discriminatory too as men don't have periods.
I think that's disgusting. And wrong. Because heavy periods in and of themselves are not a 'medical condition' surely.
Don't worry, they find things to exclude for men as well. Before we had BUPA DH dislocated his right shoulder. I declared it when I completed the forms and they didn't only exclude the right one, but the left one as well and he's never had any problems with it!
Although BUPA was great when I needed an op I'm glad it was only a simple one as I've heard quite a lot of stories about problems with cover.
Id complain and argue you had no way of knowing your periods were at all unusual and you were only using "heavy " in a laypersons way to match with descriptions of sanpro available in any shop, which could in no way be considered a medical condition.
Your consultant will probably be happy to give them an earful or write a letter, so they get paid.
I won't bore you with the details, but it was utter nonsense like this that made me sever my ties with Bupa after more years than I care to remember. My DH and I have signed up with Benenden for a fraction of the price, and although it's not insurance it does provide a safety net if we need treatment quickly.
Talk to your consultant and secretary before challenging bupa. They may well have dealt with this issue before and will know what to do.
Fact us you were treated for endometriosis, not for heavy periods or symptoms arising purely from heavy periods. Endometriosis is a medical condition. You should challenge and fight this, but get your consultant to assist you. In the meantime get bupa to out in writing exactly why they are not funding this treatment.
Had bupa already authorised investigation and treatment? If so, and if you have an authorisation code, I don't see how they can get out of it.
I had all kinds of crap from axa re gynae stuff. Got it sorted in the end.
Meant to add - it is hugely stressful when they pull this kind of stunt. Xx
Fight it. You are newly diagnosed with endometriosis which has been treated. Your periods weren't causing any problems and therefore were not a medical complaint. Ten years ffs! Could understand their stance if it was a few weeks since you joined.
Tell them you will complain to your mp and go public. I'm almost sure they will pay up if you fight.
BUPA very expensive and crap.
There are much better cheaper private healthcare providers out there. Many of these other companies take new cover on as an amnesty and don't require disclosure that later leads to conditions being excluded.
I've never had private cover but I have worked in private hospitals. Bupa try to not pay all the time. They also have their own 'rates' for what they will pay, so say they consider a hip replacement to cost £3000, that is all they pay, if your bill is £4000 then the hospital either bills you or swallows the difference, Bupa is too big for them to stop accepting their business.
Be warned, the OP has had a gynae problem which they have refused because of 'undisclosed' conditions, the fact it is her periods and that could be linked to gynae is irrelevant, if you 'fail to disclose' heavy periods they can exclude any cover so if you need an op on your hand your heavy periods could exclude you.
The other thing is that they also have clauses (lots of insurance companies do, not just health cover) about 'treatment'. So if you have a family history of heart disease that you have declared but as a precaution you have self medicated with low dose aspirin you may well be excluded from cover if you have a heart attack because you were receiving treatment.
I work for a private medical insurance firm. What you need to do is pursue this properly through bupa's complaints process, then if their final decision is 'no', then you can take the case to the financial ombudsman. Threats of media and mo's don't usually work with insurance companies.
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