Page 2 | Health insurance lapsed - I was not informed

ClaraMint · 2022-12-20T21:22:08+00:00

My ex husband and I had a verbal agreement that I would stay on his company private health insurance until our youngest reached 18 (he is now 17). He has since moved in with his new girlfriend and in July had a baby. I needed treatment and a minor op, which I preauthorised with the insurance company and booked for 20th Dec. I had pre assessment bloods and ecg on 8th Dec. I needed an admission letter for my employer and messaged his him to ask if it had been sent to his address. He replied to say I was no longer on the insurance. It turns out he removed me in November when he added his girlfriend and baby. He did not inform me of this and apparently my membership ended on 30th November. Insurance company informed me that they had no notification but it was likely when they were informed that it would be backdated. Apart from the fact my needed op will not go ahead, it looks like my pre assessment will not be covered. Who will the hospital pursue for the cost of this? Would it be the policy holder, i.e. my ex, or me, the user? If me, do I have any legal recourse against him? If he refuses to pay, I guess the cost of legal action will be more than the bill. He earns 250k, I earn 30k. It’s not fair. What are my options?

WeepingSomnambulist · 20/12/2022 23:46

mattyprice4004 · 20/12/2022 23:37

The UK consists of 4 countries, all with different laws - you’re best being specific

Show quote history

She probably means England. Most people on here who say UK mean England. When scots, Welsh or Northern Irish are asked where they are from for legal questions, they answer with Scotland, Wales or Northern Ireland.

But it doesn't really matter. The OP lives in a country with medical care. She doesnt need private medical insurance from her ex husband. It might have been in a divorce settlement in the US but it wouldnt be normal in the UK. She doeant live with him so would be unusual for his company policy to cover her anyway. He has a partner and baby so of course they should be on the policy and not his ex wife. Such an odd agreement in the first place.

BrewandBiscuit · 20/12/2022 23:55

You sound very bitter OP.

Im not sure why you think you are entitled to your ex husbands insurance policy when you child does let even live at home any more.

TurkishClouds · 20/12/2022 23:56

Company health insurance won't cover you once you are no longer living together as a couple anyway. It's not up to him to decide, it's a condition of the policy.
If he's been paying anything towards it he's been wasting his money and if you've claimed since you separated it's fraud. Which is not the trivial thing some people think it is.

LemonTT · 21/12/2022 00:12

Sorry OP it sounds like a fairly worthless promise by him. Like others it seems weird that you would be on his insurance policy if it is a company benefit. They will have limits, otherwise he could add anyone. It’s usually just dependents. Unfortunately you are not a dependent.

I could see this getting messy for him as well and that might explain why he changed retrospectively. Maybe you could ask if he will pay for the tests so you are not out of pocket. He might not want to explain why he kept you on the policy at all if you complain to the broker and they refer it back to the company.

Original poster

ClaraMint · 21/12/2022 08:27

Just to clarify I am in the UK where people can take out private health insurance as an adjunct to the NHS which often has very long waiting times. It did not occur to me to state this, as Mumsnet is a UK website. Sorry if that caused confusion.

@brewandbiscuit why do you think I sound bitter? I’m not complaining about his decision to remove me in place of his girlfriend, simply his failure to inform me. Obviously I now have to go on to the NHS waiting list for this procedure which will be at least six months.

Thanks everyone. I am going to look on the bright side and be grateful I didn't go for the surgery before I found out I was not covered.

OP posts:

BrewandBiscuit · 21/12/2022 09:05

Just the wording of your posts and the mention of the new girlfriend. Sounds very much like you are jealous that she has what you used to have.

I hope the op wasn’t something you are suffering with too badly and you get it sorted quickly.

Original poster

ClaraMint · 21/12/2022 09:09

BrewandBiscuit · 21/12/2022 09:05

Just the wording of your posts and the mention of the new girlfriend. Sounds very much like you are jealous that she has what you used to have.

I hope the op wasn’t something you are suffering with too badly and you get it sorted quickly.

Well you could not be more wrong, prior to this all was very amicable. Ridiculous to make such a judgement from my post. And this was a legal question, nothing to do with "feelings" or I would have posted on AIBU.

OP posts:

superdupernova · 21/12/2022 09:54

Sorry OP, it's crap that he didn't tell you but I don't think you would be able to make him pay for the assessments. You could try to stay amicable and ask if he could help. Explain things are tight and you wouldn't have done the assessments if you knew the insurance wouldn't cover it.

Original poster

ClaraMint · 21/12/2022 10:01

superdupernova · 21/12/2022 09:54

Sorry OP, it's crap that he didn't tell you but I don't think you would be able to make him pay for the assessments. You could try to stay amicable and ask if he could help. Explain things are tight and you wouldn't have done the assessments if you knew the insurance wouldn't cover it.

Thanks, yes this is the conclusion I am coming to.

OP posts:

RelentlessForwardProgress · 21/12/2022 10:12

I'm completely baffled by the responses on here!!!

When OP and her husband split up they agreed that until their child reached adulthood, she would still be insured for health problems.

This makes complete sense to me. Waiting times are at an all time high with the NHS, and if you have something non urgent, but debilitating, like a need for a hip op, that is a long time to be impaired. It is in her ex hubands interest that, whilst, she is providing care for their child, and until the child is an adult, that she has health cover to protect her.

The OP, knowing this was the agreement, went ahead and used the insurance. After which she was told it was no longer in force. If the OP had know she was not insured, she may have decided she did not have the funds to cover the investigations. Similarly, she might have decided to take out health insurance for herself, if she had been informed she was not insured.

If I was the OP I would be really angry about the breach of the agreement and the very difficult position she has been put in.. .She may not have anything in writing from her ex husband, but she does have proof of the cancellation mid term, her behaviour which showed she clearly had the impression she was covered, and the 'backdating' issue which is legally extremely dodgy. You can't notify someone you have ended a contract and ask them to consider it ended at a date prior to notification(!)

OP I would argue firstly that you were covered at the time you initiated the investigations (and 'backdating' the policy cancellation would not therefore remove the insurance companines liability. Secondly that your ex husband has reneged on a verbal agreement to cover you (presumably the existence of the policy running until recently supports this) and absolutely do not back down. Take it to the insurance ombudsman if necessary.

I would suggest to the ombudsman that the policy was not cancelled until notification was received by the ex husbands company that a claim was in progress, and the backdating was done in an attempt to avoid paying this claim, as that seems to be the most likely explanation here. If so they are legally liable to pay the entire claim, including the OP.

Original poster

ClaraMint · 21/12/2022 10:38

@Relentlessforwardprogress thank you so much, you have summed up the situation accurately. However I am not going to
pursue it because, as others have pointed out, the terms and conditions of the company policy may in fact restrict cover to those living with the policy holder - something neither of us had thought about.

OP posts:

Rainbowshit · 21/12/2022 11:00

I would call the insurance company. As they have not been notified of the cancellation and have pre authorised the treatment they may still cover it. Worth a try anyway.

taxpayer1 · 21/12/2022 11:32

RelentlessForwardProgress · 21/12/2022 10:12

I'm completely baffled by the responses on here!!!

When OP and her husband split up they agreed that until their child reached adulthood, she would still be insured for health problems.

This makes complete sense to me. Waiting times are at an all time high with the NHS, and if you have something non urgent, but debilitating, like a need for a hip op, that is a long time to be impaired. It is in her ex hubands interest that, whilst, she is providing care for their child, and until the child is an adult, that she has health cover to protect her.

The OP, knowing this was the agreement, went ahead and used the insurance. After which she was told it was no longer in force. If the OP had know she was not insured, she may have decided she did not have the funds to cover the investigations. Similarly, she might have decided to take out health insurance for herself, if she had been informed she was not insured.

If I was the OP I would be really angry about the breach of the agreement and the very difficult position she has been put in.. .She may not have anything in writing from her ex husband, but she does have proof of the cancellation mid term, her behaviour which showed she clearly had the impression she was covered, and the 'backdating' issue which is legally extremely dodgy. You can't notify someone you have ended a contract and ask them to consider it ended at a date prior to notification(!)

OP I would argue firstly that you were covered at the time you initiated the investigations (and 'backdating' the policy cancellation would not therefore remove the insurance companines liability. Secondly that your ex husband has reneged on a verbal agreement to cover you (presumably the existence of the policy running until recently supports this) and absolutely do not back down. Take it to the insurance ombudsman if necessary.

I would suggest to the ombudsman that the policy was not cancelled until notification was received by the ex husbands company that a claim was in progress, and the backdating was done in an attempt to avoid paying this claim, as that seems to be the most likely explanation here. If so they are legally liable to pay the entire claim, including the OP.

Maybe because it is fraud. If she is not dependent, she cannot be on his insurance.

Lalanana · 21/12/2022 11:45

I wish people wouldn't say that verbal agreements aren't valid. Except in very limited situations they are valid - here it seems very likely it's valid. The issue is evidencing them and proving the terms. OP do you have anything in writing (eg WhatsApp) evidencing the agreement with him? For example when he told you you were no longer on, did he acknowledge he'd agreed to provide?

That said, it would be a really uphill battle to get to a stage where he had to cover anything, and realistically he was always going to want to add the new baby at least. I agree that even if you can scrape together enough to make our a case against him, it's likely not going to be worth the costs of legal advice. If there is some evidence of the verbal agreement in writing then it's worth trying to push him as he may give you something. Depends if it's worth your headspace.

WeepingSomnambulist · 21/12/2022 21:37

Lalanana · 21/12/2022 11:45

I wish people wouldn't say that verbal agreements aren't valid. Except in very limited situations they are valid - here it seems very likely it's valid. The issue is evidencing them and proving the terms. OP do you have anything in writing (eg WhatsApp) evidencing the agreement with him? For example when he told you you were no longer on, did he acknowledge he'd agreed to provide?

That said, it would be a really uphill battle to get to a stage where he had to cover anything, and realistically he was always going to want to add the new baby at least. I agree that even if you can scrape together enough to make our a case against him, it's likely not going to be worth the costs of legal advice. If there is some evidence of the verbal agreement in writing then it's worth trying to push him as he may give you something. Depends if it's worth your headspace.

He can agree to anything he wants but his company will not cover her if they are not cohabiting. She wouldnt be covered. So she can go ahead and fight for it but his company will turn around and say no, you're not covered because you are not cohabiting.

Lalanana · 22/12/2022 05:00

You don't actually know that though. You're making an assumption. Yes it's possible/likely but unless you've looked at the terms of the company policy there's no way to be sure.

Also, if he has agreed to keep her on this policy, then that's his issue not hers. As I said getting enough evidence to make it worthwhile pursuing is realistically not going to happen, but there might be enough to put pressure on him to pay up for the tests that have already taken place.