Seeking Advice on Private Health Insurance Claim Rejection

[Transform_IT]

Hi everyone,

I’m going through some health issues that started around May/June of this year. I visited my GP back then, who gave me a preliminary diagnosis and referred me to a specialist. I was told the wait time to see a consultant could be up to 12 months, which led me to consider using my private medical insurance through work. I signed up for this policy with WPA in April, hoping I’d never need it, but it was there as a safety net.

As my symptoms worsened, I decided to go down the private route and contacted WPA. I had a referral letter from my GP to the consultant, and I’ve since done blood tests, had consultations, and received a diagnosis. My surgery is scheduled for November 21st.

However, this Monday, I received a letter from WPA stating they won’t cover my claim, citing that my condition existed prior to taking out the policy and that I didn’t disclose this at sign-up. I checked my online documents and found an invoice for £800 for my blood tests, as well as a letter that incorrectly stated I’d experienced symptoms since last year. I called the consultant to clarify, explaining that the symptoms and GP visit were actually from May/June this year. They corrected the report and re-uploaded it to the WPA portal. When I phoned WPA to discuss this, they agreed to send it for review, but as the claim was initially denied, it’s now with the underwriters.

I’m reaching out because I’m quite anxious about the outcome. Has anyone else dealt with a similar situation? I’m concerned that, despite the corrected report, the claim may still be denied. This treatment is urgent, as my symptoms are affecting my ability to work and live a normal life. Any advice on handling this with the insurer, or insights from others who’ve gone through similar situations, would be greatly appreciated.

Thank you for any help you can offer!

 

[Transform_IT]

If it’s with underwriters, cite treating customers fairly and the principles they must adhere to.


The mistake was made by whomever submitted the letter with incorrect information - not you. It has now been rectified, and if the only reason (as they advised) is because the symptoms were pre existing, they should now have no reason to reject it.


Good luck OP - I hope everything goes well.


When it comes to health, these situations are immensely stressful

Thank you for the kind words. Fingers crossed.

 

[Transform_IT]

Thank you for your response. I'm still in the process of challenging this issue and have had to call WPA three times to explain my situation.

The condition is not pre-existing. I initially visited my GP in early July (not May, as I previously mentioned in error) due to ongoing pain. I was prescribed cocodamol and referred for an ultrasound. My last GP visit was over a year ago for an unrelated matter. Following the ultrasound, I was advised that further intervention was necessary, with an NHS waiting time of 12–18 months. Knowing I had private healthcare starting in April, I decided to use that option instead.

I’ve been with my current employer for two years. Unfortunately, I missed the window to enroll in private healthcare during my first year, but this year I signed up through the salary sacrifice scheme.

I've called WPA again this morning, and the underwriters are questioning why there is a discrepancy between the initial letter from the consultant and a revised version. The consultant clarified it was a clerical error, and I’ve explained this multiple times to the advisors on the phone, who assured me that a note had been added to my file.

My pre-op is scheduled for this Thursday, with the operation set for the following week. However, I've just received a £750 invoice due to the claim being rejected, covering the consultation and blood tests.

I’m at a loss as to what to do next. WPA doesn’t seem to be helping, and I have no other options. I’m in severe pain daily, currently off work due to this condition, and the added stress is severely affecting my mental and physical health. The thought of having to pay this bill before Christmas, on top of the uncertainty about my upcoming operation, is overwhelming.

Given the tight timeline, how would you advise I proceed since WPA is not providing the assistance I need?

 

[Transform_IT]

Health is more important that Christmas.

I'd pay the bill and persue the claim after.
If the treatment is that important and you can afford it but it will spoil Christmas.. Christmas be damned.

Sadly it's more about the fact I have two younger children who still believe in the magic of Christmas. Plus, that invoice of £750 is only for the blood test and consultation. The operation will likely be £3,500 - £7,000.