BUPA - your thoughts on this please

[teddyandsheep]

My dc was insured on my husbands work private medical insurance (BUPA). He had to see a paediatrian when he was 1. My husband changed roles and moved to another company and joined the company (BUPA) scheme. BUPA are seeking to treat the condition my son had under the old policy as "pre-existing" and therefore not eligible.

I cannot decide - is this fair or not - thoughts/advice please.

That seems fair - your cover with BUPA wasn't continuous, so it was a pre existing condition to that cover

Was there a break in cover? Unless they agree when they take you on as part of the new scheme to continue the cover, anything that has occurred previously will be classes by the underwriters as pre-existing. Sometimes after 2 years of no treatment they will cover the condition again though, worth asking.

The cover was continuous - or if there was a break it was for a week. ie BUPA covered during the entire time but a change in policy

If he moved directly from one BUPA policy to another without a break I think they should cover. However, like any other insurance company if they can wriggle out of it they will.
We had a similarish situation with PPP, but they covered it with no quibble as there was no break in the cover.

Cover would not continuous as your cover is related to the employer who pays the contribution. So when he left the company he left the company she me and cover ceased. The fact that he ended up working for a company who also had bupa is just coincidence and has no bearing on continuation of cover.

herhonesty - the health care cover was actually paid for by us not the company - but part of a company scheme if you see what I mean.

Was it a flexible benefits scheme?

Yes it was

Thanks

We had a break - by accident - when moving countries. It was my husband's company's fault. When I rang BUPA ranting about the situation and what ifs, they told me that we would still have been covered anyway ( I can't remember the exact details). I think BUPA are being very unfair to you and you should speak to someone senior in the company.

If your cover should have been continuous, it should be covered - as a precedent, once I needed treatment and a new quote would be extortionate, but BUPA let my parents pay three years of backdated cover to keep me covered instead.

I'm afraid the end of the day, you withdrew from the contract, and entered a new contract which clearly doesn't cover pre existing conditions. The best you can do is complain via your employer ( if they are a valued customer, they may change their mind ) or take out a policy for your son which covers per existing conditions.

Sorry not to be more helpful

I've just had a dose of this with BUPA and I am very angry. I have been covered since 1980 without a break, and in May they forced me to sign up to a no pre-existing conditions clause after my husband became redundant earlier this year and I took on paying for health insurance through my own work scheme. Fine you think, caveat emptor and all that.

Except I saw the GP earlier this year to get some Tranxemic acid tablets for heavy bleeding (I have had five pregnancies, so nothing unusual there) and they are using the bleeding thing as an excuse for not covering anything gynaecological that might potentially involve bleeding of any description, which pretty much represents anything, including cancer as I understand it. They refuse to see bleeding as a symptom of a range of medical conditions and they have decided to regard it as a condition in itself.

To me the legality of this is extremely dubious, and represents adverse selection of a great swathe of the female population without a corresponding reduction in their premium. Imagine if they screened out all men who had experienced any kind of swollen or tender testicle in their entire lives, perhaps encountering this after a virus or minor injury, and then refused to cover things like testicular cancer, epididymitis, varicocele, hydrocele, and testicular torsion on the grounds that they had had testicular swelling for other reasons in the past? There would be total outcry. That is basically what BUPA is doing here. Except worse.

I am really upset at BUPA as I am ill at the moment, potentially can't get looked at in a timely manner, will now be stuck on an NHS waiting list, and given how shit I feel this it is likely to compromise me at work while I wait for the NHS cogs to turn in the way that they do. As I am the sole breadwinner at the moment we just can't afford for me to keel over.

Thanks BUPA. Thanks very fucking much.

If anyone knows any better insurers I am all ears.

I have just sent them a more polite version of that post as a formal complaint, by the way. Without the swears.

Typically the company has the power in this situation as its their premium that would be affected by any claims. I'd speak to the compensation and benefits team an ask if they could negotiate or wave the underwriting given the circumstances. I work in c&b in a competitor company to bupa and organisations approve things like this all the time - BUPA will only be following g the rules of the companies policy...

I pay the premium - it is called Eduhealth Essentials in partnership with BUPA.

I am now actually not sure now what I have actually bought and how it pieces together. Should I speak to HR and tell them I have been shafted? Then they would probably look into withdrawing it eventually if other people had problems, and replacing it with another benefit of some kind.

In my case they excluded me for heavy periods, but they are using this as a pretext for excluding all gynaecological conditions that involve bleeding, menstrual or not, and whether they developed after the underwriting date or not. I have lodged a formal complaint with BUPA after shelling out £1300 for my own hysteroscopy and £258 for my own scan, sent a solicitor's letter, and I have looked up guidance on the Ombudsman website and found this, which seems to indicate that eventually they will have to cough up, so I have no clue as to why they are being so difficult.

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undiagnosed symptoms
Problems can arise where the consumer's medical records indicate that, prior to the start of the policy, they (or their relative or pet, if relevant) were displaying symptoms that are subsequently known (or thought to be) related to the medical condition that gave rise to the claim.

In these circumstances, no diagnosis may have been made at the time the policy was taken out - and so the consumer argues that they were not aware they had the condition.

This could be the case where the consumer has been displaying symptoms that might be an indictor of a serious condition but which, equally, might be minor.

For example, a consumer suffering from headaches is not necessarily "ill" - and may not consider themselves to have a "condition" that needs to be declared. Yet if the consumer subsequently has a brain tumour diagnosed - which gives rise to an insurance claim - the headaches may well be related to this in some way.

Many insurers include wording in their policies to exclude pre-existing conditions that existed at the start of the policy but were not yet diagnosed. Even if this wording is included, we generally take the view that claims should not be excluded where the consumer had suffered only from some undiagnosed or minor generalised symptoms at the start of the policy.

However, when we decide whether a condition was "pre-existing" within the meaning of a policy, we take into account the following considerations:

the intensity of the symptoms;
the seriousness with which they were regarded;
whether the consumer was undergoing tests or had been referred to a consultant;
the eventual diagnosis;
any treatment given;
the extent of the connection between the pre-existing condition and the condition that gave rise to the claim - and the foreseeability of this; and
whether the consumer could reasonably be expected to have been aware that they might have to make a claim as a result of the symptoms.
The insurance sector accepts that ordinary consumers are not expected to have expert knowledge about the state of their health (or the health of others on whom cover depends).

We normally take the view that it is not reasonable for insurers to exclude claims - if they would have accepted the risk at proposal, had a full underwriting procedure been carried out.

Update: BUPA have coughed up after a battle. They have also apologised.

Good for you Boffin.