BUPA not giving authorisation code?

[sali33x]

Hello,

Used to have BUPA through work and have just taken privately.

Signed up with my children. Been paying a few months. Contacted this evening on online chat to get a authorisation code for an appointment I managed to get with a paediatrician on Friday for my child.

They told me I can't have one and they will have to write to my gp to check it's not a pre existing condition. (He has a massive head that has grown suddenly basically) I told them HV and gp aren't concerned but I would like a paediatrician to check as I won't get to see one through the nhs. They told me I have to cover the £50 cost the gp could charge and if they agree it's not a 'condition' they will reimburse me?

I'm fine with them checking the health records through my GP but I'm not happy that I have been paying for months and I gave them permission to access all our health records when signing up! ... for them to tell me that I now have to wait for them to contact my GP and I won't be able to attend an appointment Friday ? Is this normal? Can they do this even though when I took it out 2 months ago they could have checked everything then?

So now I could be waiting up to a month to then have to pay £50 myself for them to be able to say no ?

I'm so confused it was never like this when I had it before?

That's just how it works. They need to get confirmation from the GP that this is a new and not a pre existing issue.

They can refuse the appointment until they confirm that this is not a pre-existing condition.

Why, if it isn’t pre existing, is the GP not concerned with a massive head growth? That is more concerning than BUPA verifying that it isnt pre-existing!

Also, you usually need a GP referral to see a consultant (not just because you want to). Are you sure it’s not also to do with this? GPs usually refer privately without a second thought though tbf.

@fudgecat @Finestreason @FawnFrenchieMum

Thanks.. I know they usually need to check it's not pre existing which I understand but I thought they would have checked or got all the information 2 months ago when I gave them permission too? This is what I don't understand why would they leave it until you want a authorisation code?.. I'm confused. It was never like this when I had it through work before.

No they don't usually need a referral from a GP. I had it for three years (before last year) and never had a GP referral for any consultant I ever saw? I just called up for an authorisation code and was always given one. My sister currently has it though a different insurer and doesn't need GP referrals either.

Maybe I will check with my GP if they can do that for me then as it will be quicker then them writing to them and then waiting for them to write back with health records etc.

It depends on how it is underwritten whether or not they need a referral from a GP. Corporate policies can be very different from anything that you can buy privately. Some policies allow for self referral to certain consultants.

They can’t check for every pre existing condition before a need arises, upon application the conditions that would preclude coverage are given consideration.

Private health insurance doesn’t cover anything genetic and maybe they want to exclude that ?

However youd think they’d cover at least one consultation to help establish this.

Pre-existing is also open to question.
How do the t&c define this ?

Have you had Bupa before. For ours - Literally every time they need a referral from a GP. Or you pay a private GP for the referral.

Our policy has an excess per year of £100/£150 - so it might be cheaper to just pay to see the paediatrician out of pocket if it’s likely there’s no actual treatment needed.

Absolutely normal. Insurers can only request medical information at the time of a claim. They can’t just ask for information from your GP when you sign up.

When you had it before through work you’ll have likely had medical history disregarded whereas your kids have underwriting.

I’d be amazed if they cover this anyway, if the GP and health visitor aren’t concerned and it’s you pushing to see a paediatrician. Most private health insurance excludes cover where there are no symptoms and no concerns from the GP.

I have my teen DD with Bupa and it’s standard for them to ask your GP to complete paperwork before authorising a consultation with a new consultant/speciality. It’s annoying and from experience time consuming (3 weeks for us!) but unfortunately just the way things are

I am with axa corporate and I used to have to go to my NHS gp and say “this is wrong, please refer me, I have PHI” and they broadly would after a symptom check. Axa now has online GP service so I set up an appointment with them and they broadly do the same.

I think it’s more common than not to have a GP as the first port of call.

I have a private Bupa policy and they do need a GP referral, either your own GP, or one from their own virtual service. With all health insurance companies, company policies are different to private ones in some ways.

Just to add to what other posters have said. My work policy has always needed a referral before treatment is authorised but GPs have, so far, been happy to write one for private treatment. And I can access a private GP too.

But our corporate policy was changed this year to make it a bit less comprehensive (allowances changed etc) as there had been a lot of claims so the terms and conditions can and do change.

When did you first mention it to the GP or HV? Did you mention it at all to BUPA when you took out your membership?

When my DH retired we had the option to continue his works BUPA at XXX rate or start a new membership at XXX rate. The new membership rate was a lot lower but excluded existing conditions. It was up to us to declare what was an existing condition.

with work-bupa, I always needed a referral from GP. I wouldn't have been able to self refer to a consultant. Would you be able to see Gp and ask him to write a referral letter which you use for Bupa?

I have Bupa Global (international cover) and can self refer. But if you want to guarantee payment for any given appointment you need to get pre-authorisation in advance. Unfortunately they can decide they need to investigate if they want to and ask for extensive medical reports before you can go to the appointment. I've even had them change their mind about ongoing treatment. It's very annoying. (Oh and I paid for 3 years before I made any claims )