the times | Saturday April 9 2022 65
Money
system that relies on a GP to follow, but
if the GP doesn’t comply then you are at
a dead end.
I hope you can help as we are in a
position where we cannot get the
healthcare that we have paid for.
Ian Smith, address suppliedTroubleshooter says
We are fortunate to have the NHS
which is free at the point of service, but
health insurance can be a useful
supplement for people who want to skip
the long waiting lists. Yet Deborah’s
insurer ended up slowing things down.
To claim on a health insurance policy
you usually send the insurer a referral
letter from your doctor, which de-
scribes the kind of treatment you need.
Once the insurer confirms that your
policy covers you for treatment andI
n September 2020 my wife and I
took out a health insurance
policy with Vitality, paying a
£1,000 premium for the year.
Unfortunately she had some
stomach pains last year and her doctor
suggested seeing a consultant.
To speed this up we decided to use
our Vitality policy. When we phoned
and asked for authorisation for the
appointment, Vitality told us that
Deborah and her doctor needed to fill
in some forms.
This claim form was received and
handed in to our doctor’s surgery but
for whatever reason they would not fill
it in. We explained this to Vitality and
they said a copy of the referral letter
from doctor to a consultant would be
fine. We sent it to Vitality but it then
said the referral letter was not good
enough so we were back to square one.
Vitality then called Deborah and
gave an authorisation number so that
If you would like us to investigate
a consumer problem, write to
Troubleshooter, Times Money,
1 London Bridge Street,
London SE1 9GF or
[email protected].
Please include a phone numberKatherine
Denham
Times Money
Mentor
Troubleshooter
she could see the consultant. But after
the appointment, we received a letter
from Vitality saying that they hadn’t
approved it, even though we were given
an authorisation number. Vitality said
that it approved only the consultant
and hospital rather than the appoint-
ment so will not be paying the consult-
ant’s invoice.
Deborah now needs to go for tests
but we cannot get approval from
Vitality, which means she can’t get the
treatment she needs. Vitality has aMoney Mentor
Online
Is private health
insurance worth it?
thetimes.co.uk/money-mentorensures that the medical professional
and hospital is on its approved list, it
will give you an authorisation number
so you can book an appointment.
After the treatment, the bill is sent to
the insurer to pay.
Given that a referral letter should
have been sufficient, I wanted to know
why Vitality required your doctor to fill
in these lengthy claim forms. It
explained that it needed more medical
information about Deborah to makesure it was able to cover the costs of the
treatment and avoid unexpected costs
later down the line. It added that the
referral letter Deborah provided did
not include the level of detail needed to
make a decision.
It also said that it required more
information because she had been a
policyholder for less than a year.
But Vitality had given Deborah an
authorisation number, which meant it
had agreed to cover her treatment. So
why did the insurer then refuse to pay
the consultant’s invoice?
Vitality said: “As we understand the
pressures on GPs and the delays thisVitality held up my wife’s treatment
may cause, we verbally agreed for Mrs
Smith to book her consultation. We
confirmed that we would pay for this
appointment and follow up with the GP
afterwards. Regrettably, our system
notes were not updated to reflect the
agreement and therefore, when the
invoice was received it was declined for
payment in error.”
The good news is the invoice has now
been processed to reflect the agree-
ment of cover and the claim has now
been approved. The company offered
you £75 as an apology.
“We are very sorry that Mrs Smith
encountered difficulties during her
claim as we appreciate the additional
inconvenience and distress caused
when our members are already con-
cerned about their health,” it said
You said you are sure Vitality would
still be refusing to pay if it were not for
my intervention. You also said you
believed that Vitality is hiding behind a
system made worse by the pandemic,
knowing that GPs don’t have time to fill
in the lengthy forms it requires.
If private health insurance is so
reliant on our overstretched NHS then
it does make you question whether it’s
really worth paying the premium.GPs don’t have time to
fill in the lengthy forms
private insurers require
ILLUSTRATION BY GEORGEA EVANS