C-Section consultants covered by BUPA's "offering"

[Sparklies]

I'm 8.5 weeks so plenty of time, in theory! I have BUPA insurance and they will cover me for my medically necessary c-section. I'll be delivering at the Portland if all goes to plan.. I was tempted by the Lindo but it'll be being refurbished as far as I know, so not the same sort of standard as usual.

As many of you know, they offer £548 to cover consultant fees (ha ha). They sent us a list of four consultants who apparently will do the surgery for around that sum.

I've emailed all four.. so far only one has come back with a quote for predictably thousands.

Can anyone give me any names of anyone under £1000? Do they even exist? Most places don't have prices up after all and I don't fancy spamming over 100 consultants!!

Thanks!

TBH I dont think you are going to find one who will do it for that price, 6 years ago mine was £2000.

I'll tell you absolutely definitively: Consultants won't do a section for the amount of cover provided by BUPA, or the extra crap AXA PPP. Axa cover to £600 and gave me the details of 2 consultants who had billed for £600. When I called them they both quoted over £3k. It's utterly bollocks.

Do make sure that your BUPA insurance covers your newborn for SCBU/NICU if you deliver at the Portland. I had my DS there (under Aviva) and his SCBU bill was £12k. I'm pregnant again but AXA don't cover babies born of assisted conception, and our twins are IVF so we would have to foot the bill ourselves.

Mr.Sheridan at Watford is £3500 and the other cons are about £2.5-£3k.

I started a similar thread recently and have been looking into this. Bupa will pay surgery fee's 1 pre op and 1 post op consulatation and up to 4 nights in hospital.

I am going to Queen Charlotte's becuase they also have a NHS wing and NHS SCBU - be advised if you are at the Portland or anywhere where the SCBU is private you will pay 2k per baby per day they are in there! obviously you can't put a price on your babies health but this could work out very expensive as per BagofHolly's post.

What they don't pay is anethetists fee's £475
Paedeatrician's fee's £247 (I'm having twins) thinks it's£160 for 1 baby. The difference between the consultants surgical charge this i' still having clarified but I think depending on surgeon its from £800 upward excluding Bupa's £548 donation.

In total even with private healthcare it is going to cost me approx £1600 however in comparison to normal private charges is a bargain.

Bupa saying you are covered is a joke imho

congratulations and good luck

Thanks everyone!

BUPA confirmed they will cover £548 of the consultant including one pre-op appointment, plus (straight from an email from them, not my spellings!):

"Anaes fees we cover upto £235.00
Hospital fees cvd in full at the portland hospital for theartre charge
and upto 4 night stay
Portland do make additonal charges eg new born baby checks etc but
they will make you aware of this. as not cvd on your insurance."

We also have 30 days to add the new baby to our insurance (top level through DH's work) - they would be covered right away. That is so crap that babies born of assisted conception aren't covered.. that's crazy.

QTPie and BagofHolly - unfortunately Watford is a long, long way away from us - we're down in SE London. So although it's not impossible, it would be very inconvenient!

We don't mind paying a little over the odds for a consultant, but £2K is probably pushing it too far even with the BUPA "donation"! Might be able to stretch to below this if we are very lucky with DH's bonus next March..!

I do like the idea of Queen Charlotte's - do they still do those "natural" c-sections there, anyone know? It's just very awkward for us to get to especially by car but I'd make an exception for a "natural" section!!

Thanks again everyone - all great advice. I'll keep you updated!

I threatened to complain to the Ombudsman but we couldn't as it was a trustee policy. But I complained bitterly as it's a total misnomer on every conceivable level to say that c section is covered, and then only pay a piss-poor paltry donation of £600 towards it! That's not coverage!!!

If you DON'T have a trustee policy, I think there's defo a case for speaking to the Ombudsman about the policy limits. The woman I spoke to at AXA was ADAMANT that £600 was the going rate for c section and said that the £600 figure was a 'median' figure, decided upon by their medical department. When I went back to her and said that the consultants she had referred me to charged thousands more, she didn't have an answer other than to repeat that £600 was the policy limit. So frustrating, especially when they try and justify their own nonsense - it's an insult to our intelligence. She said that the figure had been decided upon as a c section is a short operation! Have you ever heard anything as silly? Apparently operating on effectively 3 people at once (we're having twins) is of the same surgical cost/value as say, a tricky toenail operation. I pointed out that surgeons don't charge based on the number of minutes they work, but on the risk of the procedure, but that doesn't make any difference apparently. Utterly idiotic. And I'd have had a lot more time for AXA if they HADN'T tried to defend their policy limits - not only was I annoyed by the lack of cover but felt hugely offended by being given such nonsensical 'reasons' which were clearly rubbish, in an attempt to fob me off.
AXA PPP suck. Go to Aviva, they're brilliant and don't treat you like an idiot.

It's nuts. I wonder why so many insurers insist upon such a bizarre low limit when they'll happily pay out thousands for other stuff, including alternative medicine at times. It makes no sense.

How do I know if it's a trustee policy or not?

Unfortunately we have no choice in who we're with as DH gets it through work. They've got the top level of cover with BUPA but that still only gets you £548. Considering they're paying several thousand to the Portland for the rest of it, why on earth are they scrimping on the consultant? Crazy.

Ours said so in our policy document and AXA pointed this out when I complained. My H's (very lovely) company underwrite some of the liability of the policy, and AXA administer it on their behalf. AXA initially said that the trustees (my h's company themselves, effectively) had set the policy limit of £600, but it was clear that they'd arrived at that figure on a recommendation from AXA themselves. The only recourse you have is to appeal directly to the trustees via AXA. All highly frustrating!

Paul Armstrong charges £1500 for just the section and your care in hospital, but he'll need to see you a couple of times beforehand so there's his fee to add - ends up the same price as all the others really. He's ace though - v confident and did mine. Very neat handiwork!

Just had a look at the policy document and chatted to DH and he's pretty sure it's not a trustee policy. The policy document looks like bog standard BUPA fare with nothing about anyone else paying anything. That must be super frustrating for you as of course the trustees will go on AXA's recommendation - they're not medical experts!

I wonder if anyone else has been to the ombudsman over it. BUPA have a dedicated c-section team so it's not like they don't know what's involved and that consultants are likely to charge the earth! She reassured us that the consultants she named would charge around £548. From everything I have read on here, I can only go !

Sounds like all the insurers are in cahoots with each other for whatever reason. Given they'll pay out an absolute fortune for the most crazy of things, quite why they're short-changing customers over an absolutely medically necessary c-section baffles me. It's like they think that maternity is a dirty word or something.

Thanks for the recommendation! Neat stitches are good - I was blessed with a great surgeon at Kings on the NHS (everyone was telling me how lucky I was!) and the thought of someone rubbish messing it all up makes me sad!!

That's interesting that your Bupa woman thinks she can find you someone who will do it for £548! If you do find someone, please do post their details! I am willing to put the deeds of our house on Bupa NOT being able to find anyone who will get near that price though! Do go back to them and feedback that they're talking cack!

There was someone who posted on one of my earliest ranting threads about this situation - Emmaaloo I think, who went to the ombudsman and got them to cover all her costs but she had a fight to do it.

For a while, some insurers refused to cover ANY c section but then were forced to include it in their cover as a result of changes to the sex discrimination act. But it seems they're paying lip service to 'cover' for the most part. We were with Aviva previously and they covered everything, and were also really nice to deal with too. Maureen in Women's Health was a star - it was like having an aunty who worked there, she was so helpful, yet v professional too.

One of the doctors she named was Joseph Iskaros. I'd seen him mentioned before when trawling Mumsnet when researching. I found this thread:

www.mumsnet.com/Talk/childbirth/474216-mr-joseph-iskaros-portland-any-experiences-please/AllOnOnePage

What is interesting is how the OP says she's "mostly covered"..

He's one of the people I've emailed but to be fair I sent out the email 4:30pm on a Friday so I won't be expecting to hear much back before Tuesday! I will update the thread when I hear anything.

That's very interesting that somebody went to the ombudsman and won. That means there is a precedent.. whether that has any legal standing or not I don't know but it's nice to be able to tell them that they've given in once so they can they please do it again ;-)

Very interesting about the sex discrimination stuff, I have to admit I was wondering. They say they don't like to cover medical complications arising from pregnancy because pregnancy is apparently "voluntary", but so is smoking and then getting treatment for lung cancer and a whole load of other lifestyle-choice-induced medical situations!

That URL should be:

www.mumsnet.com/Talk/childbirth/474216-mr-joseph-iskaros-portland-any-experiences-please/AllOnOnePage

Thanks QT! Yep, we were told that they only had deals with four London hospitals - Portland, Queen Charlotte's, St. Mary's and another one I've forgotten but it wasn't J&L. We also have an email with it clearly stated they'll cover four nights at the Portland, so hopefully that's enough to hang them by should they dispute it! I'm hoping because I'm lucky enough to be in a position to be able to sort it out super early (I will be getting a transabdominal stitch which means there is no way on earth baby can come out any other way!) that hopefully when the time comes it should be mostly sorted out.

Of course I'm fully expecting to be stung for unexpected things like nursery trips and of course the newborn paed check and heck, probably even charged £20 for a copy of a newspaper knowing them but so long as the bulk of it is paid, we'll survive. If we can't get a written guarantee on that, we'll just have to revert back to the NHS.

I've had run-ins with them in the past but mostly to do with my outpatients allowance at my previous company, which was as much my company's fault as it was BUPA's as they were cheapskates with cover. £1K doesn't cover the necessary consultant appointments and blood tests for even a routine operation! Thankfully our cover through DH's company is the top level one so that's one less thing to worry about.

Thanks for the words of warning over their unprofessionalism.. will definitely make sure everything is watertight as far as we can!

I'm absolutely certain they take advantage of the fact you're somewhat busy with your new baby. I really needed to put in a formal complaint over my postnatal treatment at Kings but I was just so relieved to be out of there and at home I didn't want to think of it again, especially with the sleep deprivation and exhaustion. Nobody is in a fit state to do anything!

So far I've had a quote from one of the names for several thousand, and there's no way of opting out of the antenatal care. Another one quoted £1500 without the antenatal care. Not exactly £548, is it BUPA? The third one has no availability. Just waiting to hear from the fourth. Place bets now..

BUPA talk crap. It's official. And they've clearly 'price fixed' the cover limit with the likes of the utterly crap AXA PPP.

Yes, exactly! When I was seeing a consultant for some fertility issues that BUPA did mysteriously cover, he was £200 for a ten minute appointment. I can't imagine doing a whole section for £548.. ha ha.

Needless to say I've emailed BUPA back with the "news" (the fourth suggested consultant, Mr. Iskaros, appears to be AWOL with no reply to email and voicemail on his phone) and I await their reply with.. not much hope it will be useful, frankly.

Next step, Ombudsman? :-( Any tips?