upfront surgery deposit/ UK private health insurance

[Ana19755]

Hi all,
I need some advice about my husband’s recent surgery and a mess with the surgeon’s secretary/insurance.
We had an authorised claim from our insurance provider before my husband’s surgery, and the insurer told us they would cover the full surgeon’s fee . However, just before the surgery, the surgeon’s secretary insisted we pay the entire surgeon’s fee upfront, otherwise she would cancel the appointment. She promised to reimburse the difference once the insurer makes the payment.
Under pressure, and a bit naively, we agreed and paid.
After the surgery, my husband only had one follow-up to remove the cast. When we tried to follow up about the claim, the secretary’s tone completely changed. She first claimed she had submitted the invoice but it was rejected, then gave conflicting explanations, and now refuses to respond. She hasn’t submitted the invoice to the insurer, and she hasn’t reimbursed the initial consultant fee we paid—even though the insurance company has confirmed that they have already settled it directly.
To make matters worse, our premiums will go up next year anyway because the insurer has already paid for part of the hospital and anaesthetist fees. So we’re now facing higher premiums while still being out of pocket for a large sum that should have been covered.
We’ve tried multiple times to resolve this with both the insurer and the secretary, but we’re stuck. The secretary has now become rude and told us not to contact her anymore.
My questions are:

• What can we do to force the surgeon/secretary to either submit the claim or return the money?
• Is this something we should escalate to the hospital/clinic management, the insurance ombudsman, or a regulatory body?
• Has anyone been through something similar, and how did you resolve it?

We feel very misled and are at a financial loss despite having valid cover. Any advice would be hugely appreciated.

Contact the hospital manager. Perhaps seek legal advice. CAB, should point you in the right direction. Sorry you're having such a hard time.

Raise a complaint with both the treatment provider and the insurer. The latter will have a contract with the surgeon for direct payment and this includes the surgeon not charging the patient up front. This will highlight the breach of contract, so will get involved to a degree. The former, if you get no joy, you can report to the GMC.

Who did you actually pay the money to? The surgeon, the hospital or someone else?

OP are you in the UK?

You may have to pay your excess upfront but if you give an authorisation number they can claim the rest.

Thanks, The DR for the surgeon fee

I paid the excess to the hospital because they sent the invoice immediately, and the secretary kept lying... it has been over 6 months.

That is who owes you the money.

I agree that you need to raise a complaint with both the hospital and your insurer setting out what has happened. You should exhaust that route before trying legal action.

Was the surgeon on the insurer’s approved list for the procedure at that hospital?

Thanks, yes. Big mistake, we trusted the secretary and paid a considerable lump sum from our savings. They are dodgy and we think they are trying to avoid tax...

My husband thinks the secretary has no obligation to send an invoice, so we would not achieve anything by taking legal action. Annoyed, I spent two months relentlessly pursuing and appealing our claim until the insurer finally agreed to authorise.

Have you raised any complaints as yet? The insurer will want to know as the surgeon has a contractual agreement with them that isn't being adhered to.

Is there not a way you can just submit the evidence of having settled the surgery cost to your insurer and them reimburse you directly?

private usually means 3 or more seperate invoices
the suregon often is not employed but just pays to use the facilities and you pay the suregon separate. as well as one invoice for the hospital and one for medication and possibly more (e.g. histology, anaestisist)

it is quite usual to pay the hospital up front, but that deposit should be calculated against the final bill.

you need to call the hospital admin.

and yes, it takes time for the hospital to calculate the last invoice(s). especially if labs/histology is involved)

Thanks for your replies. We did not inform the insurance company that we had paid the deposit, as we believed the insurance would not cover the surgeon’s fee if they knew we had already paid. After contacting the insurance company multiple times, the issue remains unresolved. Each time I call, I receive the same repeated information or am told to ask the surgeon's secretary to contact the insurance company directly. Unfortunately, the secretary has informed me that she does not wish to be involved any further.
This situation has caused me significant stress and anxiety, as I have been left to continually chase both parties without clear guidance on how to proceed. At this point, one option I am considering is contacting the surgeon directly, who is the head of a London NHS Hospital, although I am unsure how to find his NHS email address.

Thanks. The hospital did not ask for the deposit. We paid the deposit to the surgeon.

somehwere it should be on the Hospital website or have you looked on linked in? I recently helped someone on here to find an email (not employed by NHS) simply by googling his mane and following the trail.