BUPA "eligible treatment for delivering a baby by caesarian section" - has anyone made a claim?

[mrsm1983]

Hello all,

I am insured with BUPA who have the above policy on paying for c-sections. "eligible treatment" is defined as treatment of an acute condition, which is pretty meaningless. Has anyone made a successful claim? I am wondering exactly what the threshold is - the NHS tend to take the view that anxiety = medically necessary, and potentially also having-a-bloody-big-baby. Are private consultants generally quite good at ticking the necessary boxes or is it very difficult to get BUPA to pay out? I am just wondering what my options are, really.

Thanks very much

Have you called them and asked them what might count? I have a chronic condition, not an acute one, but it was sufficient to get my insurance companies (Aviva and then Axa, sorry, I've no experience with BUPA) to cover both my c-sections, even though their policy docs listed only a very limited set of circs in which they'd cover a section, and my condition wasn't one of them.

Have the NHS already agreed to give you a section? Perhaps see if the consultant who agreed that practises privately - s/he would probably be pretty forthcoming about your chances and would know how to write the right sort of letter to BUPA.

MrsBob - thanks very much, good ideas!

I've managed to get Cigna to cover my upcoming C Section. They said that the policy only covers issues specific to that pregnancy, which isn't quite true for the problem I have, but they have made it clear that they wouldn't pay for me to have a CS in a subsequent pregnancy as I'd know that I needed one before I got pregnant. To get them to agree to cover me I had to appeal their initial refusal, but I thought there was no loss to me in appealing the original decision. The amount they will pay will actually not cover the costs of the CS. I think it will cover the hospital stay and some of the consultant and anaesthetist fees, but I'd be surprised if they'd get out of bed for what the private health insurance companies pay.

I agree with MrsBob - my consultant wrote a letter for me to send to Cigna. I then added my own comments to Cigna's files by phone call.

BUPA paid a certain amount towards my C-section as it was deemed "medically necessary" & confirmed in writing to them by my consultant. They have a specialist C-section team, give them a call directly; they were very helpful people I have to admit, although it took a long time to get the bills settled. They wouldn't pay over £500 for consultants fees though (and try finding a consultant who will do a C-section for under £5k! but my stay in hospital was almost covered, plus I seem to remember they paid some money towards the anaesthetists fees as well. They did insist on us using a BUPA consultant (good thing mine was, as didn't have a lot of choice in the matter once he told me I needed a CS within 24 hrs - didn't give me a lot of time to arrange anything else). I think in the end about a third of the total cost was covered by BUPA.

Cigna said that they could pay for other stuff, like towards childcare if I had an NHS CS.

The hospital that I am going to has private rooms that can be used just for postnatal care, so you could have an NHS CS then private postnatal room and probably wouldn't have to pay out for that.

LadyCelia & Pico2 - thanks very much for the information. I will speak to my consultant and see where I get to!