refusal by BUPA to pay claim suffering from dementia

[spiderweb]

Has any one been refused by BUPA to settle a claim when suffering from Dementia and with what result

 

[karaokePete]

Hello @spiderweb, welcome to the forum.

It may help other members to answer you question if you gave a little more information about why a claim was refused as health insurance policies can be complicated and commonly exclude pre-existing conditions if not pre agreed.

If you don't get replies from members it may be worth trying the experts on the help line as they may have encountered the situation previously. The help line details are
National Dementia Helpline
0300 222 11 22
Our helpline advisers are here for you.
Helpline opening hours:
Monday to Wednesday 9am – 8pm
Thursday and Friday 9am – 5pm
Saturday and Sunday 10am – 4pm

Beyond that the Financial Ombudsman Service may be of use. Here's a link to their web-site http://www.financial-ombudsman.org.uk/

 

[Toony Oony]

Hi @spiderweb - welcome from me too.

As @karaokePete says, some more background would be helpful. However my understanding of all PMI's is that they will only insure against acute conditions (ie those that can improve/be cured with treatment), and not chronic ones (ongoing and incurable). Dementia is considered chronic.
Therefore as I see the situation, no claims could be made by a PWD for dementia related treatment, but if the PWD needed a joint replacement or cardiac treatment for example, that should be covered.

 

[spiderweb]

BUPA refuse to pay for op because of Dementia no other reason

 

[nitram]

BUPA refuse to pay for op because of Dementia no other reason

It might be that 'failure to disclose all medical conditions' ,or similar, rendered the policy void.

The fact that a condition is not related to dementia might not matter.

Was dementia diagnosed before or after the contract was started might be relevant.

With all insurance it is important to read the small print.

 

[Kevinl]

From an article in the FT (link below) " Bupa has also just said it will no longer cover his treatment for dementia because it is a “chronic” condition, even though he was paying premiums for nearly 20 years before the illness was diagnosed".
The article is dated 2009 so it would appear they don't cover dementia and haven't for a while.
K

https://www.ft.com/content/6b19d50a-30f4-11de-8196-00144feabdc0

 

[Beate]

It doesn't make sense though as they are not asked to treat the dementia - there is no op for it anyway. They are asked to cover an op for someone who happens to have dementia - why would that be a problem?

 

[nitram]

@Beate

Don't know if it applies to BUPA, non disclosure of all medical conditions is a common reason for policies to become void, disclosure may mean an increased premium.. Not informing of acquired conditions after contract needs a careful read of small print.

Specificity on dementia a simple operation with GA could become complex because of reaction to anaesthesia making it more expensive.

 

[spiderweb]

It might be that 'failure to disclose all medical conditions' ,or similar, rendered the policy void.

The fact that a condition is not related to dementia might not matter.

Was dementia diagnosed before or after the contract was started might be relevant.

With all insurance it is important to read the small print.

 

[spiderweb]

Hello,
Thank you for info .

 

[karaokePete]

If you feel you would like to take the matter further I would use the link I provided to the Ombudsman in my previous post. Like MIA56, I worked in claims management at one time and you will get a fair hearing as the Ombudsman will listen to your case and study the full file from the insurers as they are not allowed to hide anything.

 

[spiderweb]

@Beate

Don't know if it applies to BUPA, non disclosure of all medical conditions is a common reason for policies to become void, disclosure may mean an increased premium.. Not informing of acquired conditions after contract needs a careful read of small print.

Specificity on dementia a simple operation with GA could become complex because of reaction to anaesthesia making it more expensive.

 

[spiderweb]

It might be that 'failure to disclose all medical conditions' ,or similar, rendered the policy void.

The fact that a condition is not related to dementia might not matter.

Was dementia diagnosed before or after the contract was started might be relevant.

With all insurance it is important to read the small print.

 

[spiderweb]

thank you for info dementia diagnosed after contract

 

[nitram]

Did the small print say you had to disclose the condition either on diagnosis or renewal.
You inadvertently might have agreed to 'no change' on renewal.

 

[spiderweb]

FSA will not uphold claim reason given it was not Insurance comp that refused treatment but Private hospital.nothing in policy stating dementia is not covered or in renewal notice or we should advise of change of health . Does anyone have any knowledge

 

[Louise7]

A recent thread covered why private hospitals will not treat dementia patients: https://forum.alzheimers.org.uk/thr...peration-due-to-dementia.112280/#post-1583317