BUPA insurance - help needed to make a complaint please

[Follycastle]

I’m trying to make a complaint against BUPA and would love some help please.

I have a policy with my employer, for which I get two allowances, one for mental health and one for outpatients.

Earlier this year I had some mental health treatment authorised. I was told that if I exceeded my MH allowance, I could use the outpatient one. I’m sure I asked at this point whether I would be told if one had been exceeded but I don’t honestly remember (my MH was in the toilet, so not a great time to remember that sort of thing).

I didn’t really give any of it another thought until a claim advice landed this morning (three weeks after date of letter due to strikes) which says I owe the provider of my treatment over £200 as my allowances have been exceeded. I have had further treatment since because I didn’t know I’d exceeded, which will mean I will end up owing them over £400

I’ve queried and they won’t budge, but my point of complaint is that this is a huge lack of transparency/communication from them. In none of my communications from them over the course of the last few months (and I’ve had regular claim advices) have they included a “remaining balance” or similar, they didn’t consider alternative communication during the postal strike (eg text or email) which could have at least prevented me getting further treatment that I’d have to pay full price for. When I raised this over the phone they said they expect their customers to know whether they are close to their allowance and couldn’t remind customers.

I am scouring the FCA Insurance: Conduct of Business Sourcebook in the hope I can throw the rule book at them, but can any knowledgeable mumsnetters help me out? I work in a similar industry and this just feels wrong to me.

No advice on the complaint but do you owe the money to BUPA or to the care provider?

If it is the latter then you can negotiate.

I used to work in a private hospital and they negotiate all the time with insurers, self funders often pay more.

Eg an Insurance company will tell a hospital a Hip transplant costs say £10 000 and that is all they pay to each hospital. An individual may get a bill for £12 000.

Actually the person who I was replying to here didn’t “take time out of their busy to day to help”, they took “time out of their busy day” to provide an opinion which didn’t serve any other purpose than to belittle me, which isn’t really the same thing is it? They certainly didn’t provide any “legal matters” support did they?

You will see in my next response I thanked everyone who has helped, and not thrown my toys out of the pram, at all. I also have made a number other replies, none of which show any “unkindness” (again, not even sure I was unkind to the PP by comparison by hey ho) but you’ve still chosen to berate me for this one comment?

Maybe you and the PP you have quoted are the ones not showing kindness? I haven’t been unkind to anyone here, but you have both chosen to reply to a thread where you can’t help. Like I say, that is more in the spirit of AIBU, so that’s why I asked if the PP was lost.

Once again thank you to everyone who provided more constructive responses. I’ve got a few things to try here, including negotiation with the provider. I don’t expect BUPA to cough up (unless they agree to move to my husband’s policy) but I still think the complaint is worth making to provide feedback which could protect consumers, especially those who are vulnerable.

I would also look at what was authorised in August - who was this communication between - were the care providers aware of what had been approved - eg was there some communication that stated there was X,000 available that would cover Y weekly sessions. I hope you manage to find a solution.