Medical insurance - Refused claim: non-approved consultant/specialist

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Based on resolver’s experience to date, you should always contact your insurer before going ahead with any medical treatment – otherwise you may have the unpleasant surprise – and expense – when you realise that you are not covered. Check your medical insurance policy small print carefully as there may be exclusions to the cover offered. Insurers will often cover the costs of a consultation with a specialist chosen from those on its approved list. Your GP may be able to recommend one from your insurer’s list. Be aware that if you see a specialist whose name is not on your insurer’s approved list then you run the risk of not being covered for your claim.

If you disagree with your insurer’s findings you should complain to the company directly. Ask for an address for customer services, and write giving clear details of your case - such as what treatment is sought, why this specialist must be used and why your insurer should permit you to make use of him. If you are not happy with the outcome then as a last resort you can contact the Ombudsman, which will act as a mediator in your case. resolver recommends that you submit your concern in writing and resolver can assist you in submitting, recording and reminding you when and who to escalate to.

Resolver can help you resolve this issue quickly, free of charge and without the hassle. We can also help you with the next step of writing your complaint. Click on the link below to create your email.
You should know
  • If you’re making a complaint about making an insurance claim rather than a mis-sold policy, check your documents to see who the “underwriter” is. You’ll need to make a complaint to that organisation.

If you cannot resolve your issue you cannot raise your case to the Ombudsman until 8 weeks after you have first raised your complaint with your provider, or you have received a ‘letter of deadlock’ from the company stating that they cannot resolve the issue as you have asked. Your complaint must also not be older than 9 months. For an accurate decision by the Ombudsman you should provide a detailed file of your communications and supporting documentation. In addition make sure you explain what you want as an outcome as this will help assess your case.

 

 

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