Yet another eventful day full of hospital visits!!!

[GarethB]

Just as you think you escape the eye unit, you end up in eye casualty

Yup, while in hospital in my home town for an exploratory operation which thanfully was clear so I am on a low salt diet full of dairy products!!! So no longer one bag of crisps a day, but one a week.

Yes while getting ready for theatre, took my lenses out as I had to drive there and what was on the white of my eye that was not there at 6am, but a small spot of blood. Spoke to the doctor, he calls the eye unit in Coventry who ask me to attend eye casualty ASAP once my op is over.

Get to eye casualty and the spot is bigger, result is somehow I have burst a bllod vesssel on the sclera, fortunatly in the outside corner of my righht eye well clear of the graft, but at least the doctors wanted to check that no further damage would occur by further lens wear and that chances of it spreading to near the grfat to cause problems was practically zero. Just need to keep an eye on it to ensure the red spot goes down and that it stays pain free.

Everyone in the Coventry and Wrwickshire NHS Trust have given excelent service which is far better and quicker than anything I have received in all my years a private patient.

Good chance the BUPA will be cancelled as they nolonger cover KC, anything to do with my joints or my digestive system. This is despite being with them since the mid-eightees, but as there has been a change in who pays the policy they have takien this as a break in cover which gives an excuse for refusing to cover past conditions.

Still smiling, going to indulge in a Chineese meal before starting the new diet and a bottle of wine too.

CHEERS

[jayuk]

Gareth

Thats the only down side of Paying BUPA by yourself as opposed to through a company. Via the work route its Occupational Cover and thus they cover practically everything past or present..or at least thats how mine is. Its also sad that it matters WHO you work for as well!......To me thats the utter piss take!...if you are with a large corporate which has 1'000' employees on the plan then they dont mess with you as one simple call to HR puts them in place.......Utter liberty!!

Im glad that the blood spec wasnt anything serious though!!....for what its worth i had 3 blood vessels burst towards the end of the graft procedure!....(during the haemorage)!...

J

[Andrew MacLean]

Gareth

I admire you, not least for the fact that you reward yourself with a Chinese meal BEFORE the diet.

Now that's panache.

Andrew

ps what a scary day. all the best.
A

[GarethB]

Jay,

I have never paid for BUPA, it has always been the companies I have worked for except between mid eighties to start of the 90's when I was in eductaion and then it was the company my Dad worked for.

To be honest I feel health insurance is like any other type of insurance, if they can take your money and get out of paying up when there is need for a claim, they will.

[jayuk]

Gareth

Thats just even worse then!! You know why?

When I was having my graft done last year, I was going to fund the procedure myself, and then was told by my workplace that BUPA would cover it. So I pointed out that it was an existing condition blah blah...and was told by my HR dept that it doesnt matter as its Occupational Health Cover...which means to a large extent all illnesses are covered. So off I trotted and foned them up...within one hour I got my Charge Code, a confirmed appt to see C4S and all was fine. I then went to the appt, and as expected we arranged the Transplant.

Here is where it got funny.....C4S was not on BUPA's authorised outlets and therefore they said I MAY not be covered. Now I didnt want to have it done anywhere else at this stage as a lot of time and effort went into the diagnoses, tests, screening, etc etc. So I got on the fone back to the Insurer and THEN was told that the Transplant type may not be covered! So at this stage I am a little mad! Well anyway, to cut a very long story short, I got my HR director involved and within one fone call to the Alliance Partner (the team that basically sold the whole cover to the corporate) everything was covered, all were insured and I got a call from Bupa apologising for the mishap!

NOW! What still annoyed me here was the fact that this had to happen?..Why did I need to escalate this matter? MONEY! As you rightly pointed out , if they think they can get away with it then they WILL!!. One thing I have learnt is that if you escalate even to the Insurer direct and reason sometimes you do get whats right!..Its just that they are not used to people coming back and arguing the point across! Makes me soo mad how they operate!


Jay

[Andrew MacLean]

Oh well. Poor clergymen can't afford health insurance, and the church doesn't pay!

Still, I wasn't always a cleergyman and when pushed I used to escalate very rapidly through the hierarchies with which I was dealing. On one occasion I spoke direct to the President's office of an American Multi-National that was messing me about.

I think it helped quite a lot that I was right and they were wrong, but the problem was that down the scale nobody seemed to be authorized to depart from the corporate script. The situation I was negotiating was out of the ordinary, so did not seemed to be covered by their programmed responses.

Gareth, I'd say escalate. Even if you don't get what you seem to be entitled to receive, you will at least have the satisfaction of knowing the people up the chain know how upset you are about it.

Andrew

[GarethB]

Tried escalating it, but we nolonger have occupational health on site, so I took it up with our employee forum which basically raisies these issues with local HR and the UK wide HR for the company.

Still told not coverd so HR are backing up BUPA in this case.

Stick to NHS as they are exceptional where I live.

[John Smith]

This is the age-old problem.

I used to be with BUPA, and found them most helpful. They paid for my graft, which was indeed a pre-existing condition, and were happy to continue to pay for all the aftercare.

My company then changed insurers to Axa PPP who are dire (even my consultant complains about them!) Their blurb specifically mentions that PK is covered but lamellar is not, and that they won't cover any chronic conditions (but they will cover a change in that condition for one or two visits).

I escalated through corporate HR, and was told that I had nothing to worry about as they were contracted to provide the same service as BUPA had. All was indeed well.

Until recently. Now they're trying really hard not to pay for aftercare at all as it is a chronic condition. When we argued (even via HR) that they were covering as BUPA had, "only for the first year!" was their reply!

Still, changing company again soon so will have to see what another insurance firm is like. Ho hum.

But a closing thought, how come BUPA is happy to pay for a lifetime's aftercare for a graft, but not a scleral lens? Because they think that contact lenses are purely for vain people!

[jayuk]

OK lol

Bit cheeky but this is what I did last year

As part of my "Out patients" for the graft I think I am limited to £1500 per 12 month period. Each time i visit for my outpatients I get charged £110, this is settled happily with Bupa. No had one iota of an issue

Last year I also saw Ken for a bespoke Scleral and thus the total invesitgative cost was around £300 odd. So i thought, well let me pass this on to Bupa...so there I did.....3 weeks later I got 70% of the amount back..BUT they took it off the Outpatients budget!...lol..Slimey but there you go!

In all honesty, these ppl will try and do everything they can to get out of it. And do bear in mind that alot of the ppl that make these decisions are admin staff whom authorise and reject claims based on a criteria which they tick off against. If a claim they have does not meet all the criteria than its passed onto there Line Manager and it can be passed AT THERE DISCRETION....and normally that means HOW big the whole deal with the company is worth!...

So if you are with a company with 3000 employees and they are paying £60 a head for full cover than thats £2.1 million a year!...They know that if someone does escalate to HR (which generally make the decisions on vendors) then its not going to look good! So they make a judgement on cost v hassle v repeat business!

Money Money Money!!! What a world!

[Per]

I haven´t read all posts here. But is it so in UK you get this surgery covered only if you have insurance, otherwise you have to cover it yourself? And how much does i cost? I thougt the public health authorities covered this.