Recently my stepdaughter received confirmation from her GP additional tests were required for an issue that had arisen.
Both she and her Mum were somewhat disturbed that the waiting time for the test would be over 2 months. As my stepdaughter had private medical cover through her employer, she duly contacted her insurance company and was authorised to see a private consultant. Off she went. No issues and a precautionary follow up arranged for a couple of months later. The benefits of having private medical cover were apparent – much shorter waiting time.
Mindful of the world I’m in, I asked if she was sure she was covered for everything. Yes, she replied; she hadn’t checked because her employer-provided the policy, therefore, she was fully covered. So I waited for the “oops – no I’m not” moment.
Sure enough, shortly after, a letter arrived stating that whilst the test was covered by her insurance the consultation(s) themselves were not. How could this be? She had contacted her insurance company and been authorised. Her insurance company made the classic reference to the small print when the point was pursued further. By no means am I suggesting all PMI companies fail to point such things out but empirical evidence indicates sometimes they don’t?
So why had the fact consultations were NOT covered been left unexplained to her?
The other classic reference of it being her responsibility to check the exact offering of the policy was made. That just doesn’t cut it for me. The PMI should have been completely transparent and explained what was or was not covered. This is something my guys (more specifically their med-secs) are asked to bring to the patient’s attention when the initial consultation is arranged. Again and again I both see and hear patients stating they were unaware that certain items are not covered by insurance.
They have private medical insurance and that’s the end of it as far as they are concerned.
It’s why MHM clients are advised to enquire if their patient has confirmed precisely what is or is not covered by their private medical insurance.