Warning-pitfalls of heathcare

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Chris Pope
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Warning-pitfalls of heathcare

Postby Chris Pope » Wed 13 Feb 2008 6:22 pm

I have had a graft recently (last Wednesday) and thought i would point out a couple of pitfalls of private healthcare.

My company provide me with private medical cover with XXXX under something called a network scheme. I have been using this scheme to visit my consultant a couple of times a year for the last few years without any previous problems.
Once I decided in January to have the graft done I contacted XXXX and was told they would cover the procedure no problem.
After everything had been arranged XXXX then claimed that the operation could not be carried out in the NHS hospital my consultant uses for eye operations. They claimed it had to be in one of there network hospitals and would only consider the NHS hospital if the procedure was not available at one of there network hospitals within 20 miles of my address. My consultant rang them & informed them that he ONLY does this operation at this hospital and that now would not be a good time to try out new arrangements. XXXX stood firm even stating that they would find me a consultant who could carry out the op at one of there hospitals. Despite my pleas they refused to budge and failed to see my concerns over changing my consultant at this stage.
Luckily I work for a large company who contacted XXXX and put them under a bit of pressure which caused them to stand down and allow the use of the hospital.
Now I thought the problems with XXXX were finished and I could get on with the op worry free, how wrong could I be!!!
I found out that although the operation was covered I only had £500 per year to use on what they referred to as out patient costs. This is supposed to cover all consultations and any tests (including pre med's) that are required. I had already seen him twice this year so far and had just had my pre meds done to be told that I had only £100 left for the year days before the op. I pointed out to XXXX that it was standard to see the consultant 12-20 times post op in the first year and this would never cover all of the treatment needed. I was told that when the £100 ran out (effectively 1 visit after the op) I had to pay for anything else myself from that point.
Lucky for me I have a very understanding consultant who is now going to transfer my after care over to the NHS to ensure that I get all the correct treatment without me having to re mortgage. This is a major relief at this stage and I now feel I can concentrate on getting better without any future worry.
Just goes to show that private health care is not always what’s its cracked up to be when portrayed in those glossy ads.
Let me know if anybody has any question I can help with.
Chris

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Andrew MacLean
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Re: Warning-pitfalls of heathcare

Postby Andrew MacLean » Wed 13 Feb 2008 6:59 pm

I have heard of this sort of thing before, but never relating to ophthalmological surgery. Frankly I am appalled; like most people I think I had assumed that you pay the premium to increase your choice of hospitals etc, not to have your choice limited.

(In this case it is your employer who pays the premium, but the principle is still the same).

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Anne B
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Re: Warning-pitfalls of heathcare

Postby Anne B » Wed 13 Feb 2008 8:36 pm

I have had both my grafts done through private health care and they have been great. I use XXX.
The only things we have had to pay for are medication which is easily sorted as my GP changes my private prescriptions in to NHS . Actually sometimes it is cheaper to pay for the private prescription so i always check .
I have had 2 grafts in a year and been to theate to have a stitch put in. I have to have regular blood tests and that is all covered.
It's a shame you have had so many problems. It's bad enough having to have a graft let alone having to worry about all of that.
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AlexMorgan
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Re: Warning-pitfalls of heathcare

Postby AlexMorgan » Wed 13 Feb 2008 9:11 pm

I am currently thinking signing up for private cover. Which one would members recommend?

Chris Pope
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Re: Warning-pitfalls of heathcare

Postby Chris Pope » Wed 13 Feb 2008 11:21 pm

My post was not meant to be a slur on XXXXX but rather pointing out some problems of my private cover that as a member I was unaware of until I needed it.

The restrictions on my policy was a result of the type of policy that ultimately my company bought into and not me.

My mother in law recently had a mystery pain in her side and had private cover with work through an insurance company. She saw about six different consultant and has had many many tests to try to get the bottom of the problem without any pot of cash / allowance running out. So the problems I had / have are not relevant to all polices.

I don't speak through personal experience but I have been told by others since that you can often get a better level of cover if you use an insurance company rather than a health provider like XXXXX.

The motto for me is to know what is covered before you need it, otherwise like me it gives you something else to worry about just at the time you least need it.
Chris

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GarethB
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Re: Warning-pitfalls of heathcare

Postby GarethB » Thu 14 Feb 2008 8:22 am

Although the original post meant nothing maliceous in my opinion against a particular health care company, but just warning to check carefully what you are coverd for.

The Keratoconus Group is very lenient when it comes to naming companies/organisations. However as the company named could take offence I have edited all above posts and hopefully removed all the names.

Unfortunatly we have had posts in a well meaning manner naming organisations before and subsequently threatend with legal action.

Thanks

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melissa
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Re: Warning-pitfalls of heathcare

Postby melissa » Sat 16 Feb 2008 3:47 pm

In SA Medical Aid (insurance) is very common. Our public medical health system is in disarray and i would not be happy to rely on that. almost everyone who has a full time job has private medical insurance. its BIG business.
however, we also have loopholes in the insurance. Luckily I have been involved in making recent decisions regarding the plan we offer to our employees, and as a result was already aware of the 'gaps'. for example the medical aid only pays approx.half of the specialist's fees. they say in their brochure that they pay 200% of the 'medical aid tarriff', but these specialists generally charge 400%.. so you sneakily get a bill afterwards. for my graft i would have had to chip in approximately R4000 ( 270pounds) for the opthalmologist and the anaethetist. luckily i new about it and had taken extra 'Gap cover' in january and paid one premium (R55). that's a bargain if you ask me.
My advice- Question everything!

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Re: Warning-pitfalls of heathcare

Postby amacuk » Sat 08 Mar 2008 9:22 pm

Hello.

I have had 2 grafts in the last 9 months, the most recent being Wednesday....

BUPA paid up no problem for last year, and CIGNA just happily paid for this one.

Good luck.

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Andrew MacLean
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Re: Warning-pitfalls of heathcare

Postby Andrew MacLean » Sun 09 Mar 2008 8:19 am

I think that the best advice to anyone thinking about any sort of insurance contract is to find out in advance what is included and what is excluded.

If the contract on offer does not fulfill your needs then you could either negotiate (which is tremendous fun) or go to another provider. If the insurance comes as past of an employment package, ask for sight of the contract terms and conditions. Again, if they do not meet your requirements you could either go back to your employer and find out how much they want to keep you; you could obtain additional insurance or you could do what I do: rely on the excellent service available free at the point of delivery in the National Health Service! :D

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robcm
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Re: Warning-pitfalls of heathcare

Postby robcm » Thu 01 May 2008 9:46 am

hope noone minds me resurrecting a dormant post... i'm about to have a graft with XXX cover and am wondering about the take home prescription - did you have to pay for it yourself or was that covered. and what sort of pain relief did people need in the immediate post op period?

rob


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