private health cover bastards

[2seas]

so last week i dislocated my knee playing football. it banged back in place when i hit the ground. i decided to tough it out and not go to hospital (couldn't be bothered with a 4 hour wait for an x-ray). a week later (yesterday) it has settled down a bit and movement is returning but i decided to see a gp just for some advice. my gp advised i should get some physio and gave me a referral form.

i took this referral to my private health cover, pru health, (to whom i've been paying hundreds of pounds a year for 2 years without making any claims yet) and they told me they wont offer me physio because i didn't have an overnight stay in hospital!

so the way i see it if i had decided to 'milk it' after my dislocation and go to hospital and stay overnight (which would have used up a bed someone else may have needed) they would be comping my physio now.

am i right to feel slightly outraged here? i imagine there is absolutely nothing i can do - as the stupid clause is in the fine print..

[ucb]

OMG a downside to private medical insurance!

Sorry, I do sympathise with your situation. It's just that I am sick to the bloody teeth with yanks telling me how much better their system of private coverage is than 'socialised' medicine.
I hope your knee gets better soon.

[ucb]

Oh, and just to say that I know you arent an American!

[anonymous-user]

I've had axa ppp cover physio based on a referral from a GP without any hospital stays etc.

[Soovy]

2seas said:

I imagine there is absolutely nothing i can do - as the stupid clause is in the fine print..

..... which obviously your read and considered before paying then all that money?!

[Bill]

Soovy said:

2seas said:

I imagine there is absolutely nothing i can do - as the stupid clause is in the fine print..

..... which obviously your read and considered before paying then all that money?!

Sorry OP, but you only have low level cover.

On the positive side you can afford to pay for private physio with the money you saved not paying full premium.

[Soovy]

swerni said:

el stovey said:

I've had axa ppp cover physio based on a referral from a GP without any hospital stays etc.

So does my BUPA cover.

They just paid for me visits to consultant about my knee and the resulting MRI scan.
They would have covered physio but it wasn't required.

A descent private health policy can be priceless.

I'm glad I haven't had to pay for my medical bills over the past few years

F ck me mate. Master of understatement there!!!

[Pickled Piper]

You need to check the paperwork.

Go back to your GP, tell him /her your knee hurts and asked to be referred to a specialist on your private health cover. GP will refer you to a Consultant. Consultant will assess you, maybe order a scan and then probably refer you to for Physio.

You have to know how the system works.

I had similar issues when I tried to get a hearing test privately. Private health care wouldn't do this but they would cover me to see a consultant who then referred me for a hearing test.

pp

[2seas]

Pickled Piper said:

You need to check the paperwork.

Go back to your GP, tell him /her your knee hurts and asked to be referred to a specialist on your private health cover. GP will refer you to a Consultant. Consultant will assess you, maybe order a scan and then probably refer you to for Physio.

You have to know how the system works.

I had similar issues when I tried to get a hearing test privately. Private health care wouldn't do this but they would cover me to see a consultant who then referred me for a hearing test.

pp

great response! so perhaps there is a loophole. i'll investigate this...

i pay something like £30 a month at the moment for my cover - so for those who replied to say that their physio was covered in their policies, do you pay more than this? I estimate i have spent

frankly i'm going to switch as soon as i come to renewal because whether i should have read the finer detail or not their policy is still flawed (logically and morally), so screw them.

[51mes]

I would be careful about switching if you think the knee is going to be long term...

the new provider will have the wonderful get out clause of "exisiting condition"..... and yes they do use that one as often as they can.

Simes

[2seas]

51mes said:

I would be careful about switching if you think the knee is going to be long term...

the new provider will have the wonderful get out clause of "exisiting condition"..... and yes they do use that one as often as they can.

Simes

good point! bugger.

[2seas]

just got a call from the NHS with a slot for physio! only a few days after requesting it!

good old nhs - why did i doubt you?!

[piquet]

2seas said:

so last week i dislocated my knee playing football. it banged back in place when i hit the ground. i decided to tough it out and not go to hospital (couldn't be bothered with a 4 hour wait for an x-ray). a week later (yesterday) it has settled down a bit and movement is returning but i decided to see a gp just for some advice. my gp advised i should get some physio and gave me a referral form.

i took this referral to my private health cover, pru health, (to whom i've been paying hundreds of pounds a year for 2 years without making any claims yet) and they told me they wont offer me physio because i didn't have an overnight stay in hospital!

so the way i see it if i had decided to 'milk it' after my dislocation and go to hospital and stay overnight (which would have used up a bed someone else may have needed) they would be comping my physio now.

am i right to feel slightly outraged here? i imagine there is absolutely nothing i can do - as the stupid clause is in the fine print..

sorry to shatter the illusion, but even if you had waited at A&E, post reduction dislocated patellas don;t get admitted, you would have either been sent home in plaster or a cricket pad splint, if these are the terms of your cover, you could never have got physio

[2seas]

piquet said:

2seas said:

so last week i dislocated my knee playing football. it banged back in place when i hit the ground. i decided to tough it out and not go to hospital (couldn't be bothered with a 4 hour wait for an x-ray). a week later (yesterday) it has settled down a bit and movement is returning but i decided to see a gp just for some advice. my gp advised i should get some physio and gave me a referral form.

i took this referral to my private health cover, pru health, (to whom i've been paying hundreds of pounds a year for 2 years without making any claims yet) and they told me they wont offer me physio because i didn't have an overnight stay in hospital!

so the way i see it if i had decided to 'milk it' after my dislocation and go to hospital and stay overnight (which would have used up a bed someone else may have needed) they would be comping my physio now.

am i right to feel slightly outraged here? i imagine there is absolutely nothing i can do - as the stupid clause is in the fine print..

sorry to shatter the illusion, but even if you had waited at A&E, post reduction dislocated patellas don;t get admitted, you would have either been sent home in plaster or a cricket pad splint, if these are the terms of your cover, you could never have got physio

really? i was asked to stay overnight post reduction after i dislocated my shoulder...

i'm not saying you're wrong - perhaps the shoulder thing was a one off. but if there are no circumstances for which a dislocated joint wouldn't require admission then why have a clause saying that admission would be required for physio - other than to ensure noone would ever qualify for physio, which would be an outrage in itself...

[btom]

2seas said:

i'm not saying you're wrong - perhaps the shoulder thing was a one off. but if there are no circumstances for which a dislocated joint wouldn't require admission then why have a clause saying that admission would be required for physio - other than to ensure noone would ever qualify for physio, which would be an outrage in itself...

Most Health insurers use GPs as the gatekeepers for referrals, having an extra level of qualification (i.e. you then have to stay in hospital overnight) allows the insurer to further indemnify it against having to cover. I am not saying this is what your insurer has done in this case.... but many insurers offer low cost options that have clauses that can be 'restrictive.'

51mes said:

I would be careful about switching if you think the knee is going to be long term...

the new provider will have the wonderful get out clause of "exisiting condition"..... and yes they do use that one as often as they can.

Most definately, if GPs represent the 1st line of defence against insurers costs then 'exisiting conditions' represent their most effective client retention tool.

ALWAYS read the small print. Sorry, not helpful to you in this case OP.

[Bill]

2seas said:

really? i was asked to stay overnight post reduction after i dislocated my shoulder...

i'm not saying you're wrong - perhaps the shoulder thing was a one off. but if there are no circumstances for which a dislocated joint wouldn't require admission then why have a clause saying that admission would be required for physio - other than to ensure noone would ever qualify for physio, which would be an outrage in itself...

There may well have been other circumstances surrounding your dislocation that made a stay necessary as it's unusual (IME).

Most sports injuries/back pain/whiplash etc don't require a hospital stay so the clause is a bit cheeky, particularly as most physio referrals following an inpatient stay would be considered urgent and should be seen in a fortnight or so.*

*Waiting times can go up as well as down, local terms apply etc etc