What would you do????

[mynaughtylittlesister]

We are very fortunate to have private medical cover as part of DH work package. If DH didn't have this package then there is no way we could have afforded it in the first place!

I have had an awful lot of problems with my sinuses over the last yr. Started to see a private consultant last September, eventually had an operation in January, but unfortunately for me still having nasty sinus infections every few weeks.

Here is my dilema!!!

I knew that my funding was almost used up to see the consultant, so I rang the health scheme to see what would happened as my allowance was almost used up, they told me that I had £26.20 in the "pot", so to speak and would continue to pay for the procedures etc but not for the actual consultations. They even gave me a code for the procedure.

I then spoke to the Consultants secretary and she said that they would go through health scheme first and then bill me the difference.

I saw the Consultant last week, and today I received a letter from the health scheme. They have paid for the whole of the appointment including the consultation - I am now truly confused as I thought I would be paying for most of it (excluding the £26.20 that was in my "pot")

I have been honest with them by ringing them in the first place and asking what happens, I am wondering if this is a gesture of good will, or a mistake or what?????

I am very confused, also a bit relieved as I am very strapped for cash and it would have taken a huge chunk of my monthly out goings!

Hmm!

i have the same policy where you pay for your consultations and not the procedures,xrays,bloods,MRI scans etc. They will probably check later on and rebill you. It happened to me. I think my yearly consultation allowance is £500

Okay thanks. Just wondered that I had been honest with them in the beginning, have only used my allowance up on this consultant etc, that maybe they would let the payment go! Will keep some money aside just in case they ask for it.

Did think it was kind of strange, and also felt kind of guilty too!

they are normally on the ball and dont allow you to go over unless your policy renews in april like mine and then you get your new allowance

Your post is a bit confusing TBH!

I know exactly what you mean as am in the same situation most years; I have had regular 3-monthly scans/blood tests and they use up a lot of my out patient's allowance- which is around £900 pa. Th e insurers now won't pay for them at all so I have to pay as they regard the situation as on going, not acute. I now have an annual scan costing £240 and have to pay for it.

This is also something you need to watch if you keep going back to the consultant for the same condition.

However, in your case I wonder if the invoice the dr's sec submitted itemised the 2 different costs- one for a procedure and the other for the consultation? If they were lumped together then that might be why they paid in full.

Sorry didn't mean it to be confusing!

What I am trying to say and I didn't state this last night, was - I had spoken with health scheme before my last consultation because I knew that my limit was almost up, they advised me that they would still pay for the procedure just not the consultation. They even gave me a procedure code for it which I passed on to the secretary.

Pretty sure they didn't lump everything together as the invoice I have for the treatment has everything singled out!

I will watch out about going to consultant with the same thing, luckily for me we have had this "perk" for about 5 yrs now, and this is the first year I have used it for my sinuses!

Many thanks

They might have paid him in full for "ease of administration" and you might get the bill for the difference any day!

You can have more consultations re a condition but it all depends on when they decide it is "chronic"- I had 3-4 scans for an ovarian cyst then they took issue and said it was chronic not acute and agreed to pay for 1 more then that would be it.

I then had a problem as I needed another gynae investigation which was not connected - or could possibly have been- and had a bit of a palava with them- it was a new condition which had to be set up as a completely new claim, and they needed to know my GP was aware of it, even though the consultant was the one whose care I was under and who was monitoring it all.

Having said that I have found them very reasonable and would not be without private health care.