Insurance Dispute for Visitor Hospitalisation Cover with Bupa - Advice for Next Steps

kaleidoscope on 23/07/2020 - 01:16
Last edited 05/08/2020 - 08:31

Update:
We’ve asked for an extension from hospital and followed up with Bupa for an internal review. This changed their initial decision and they’d since paid the remaining balance to hospital.

Thanks for the helpful advice.

————
Hello all,
Seeking advice for next steps to be followed for an Insurance claim dispute with Bupa for a visitor hospitalization charges.

Couple of months ago a relation of mine (a visitor) was hospitalized for few days following a medical emergency. We got letter today from Hospital that Bupa only covered small part of the charges and we have to pay the balance by due date (about a week from now). Our insurance for visitor with Bupa covers all charges including hospitalization stay and other related treatment according to the pds.
In addition our GP has already submitted a supporting letter that this emergency was not due to a pre-existing condition and despite all of that Bupa's decided against it.

Should I inform hospital there is a payment dispute with Bupa and ask for an extension until it's resolved or should I pay the balance and try to recover it from Bupa or is there different a better way?
I'll be filing a complain with ombudsman tomorrow anyway, but with regards to the payment not sure whats the best course of action.

Is there anything else I should be aware of? Asking this as it's my first time handling an insurance claim dispute.

Thanks,

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closed Comments

  • randombrick on 23/07/2020 - 01:56

    I would ask for an extension.

    What reason did BUPA give for rejecting the claim?

    • kaleidoscope on 23/07/2020 - 02:02

      Thanks.
      They rejected stating pre existing condition.

  • holdenmg on 23/07/2020 - 04:45
    +5

    BUPA may seek a report from their usual Doctor.
    Not necessarily the Doctor your relative used while here.

    In the alternative, do they have a claim under Travel Insurance?

  • EightImmortals on 23/07/2020 - 07:46
    +2

    Inform the hospital of what's going on, if you pay them the money you'll probably never see it again.

  • oscargamer on 23/07/2020 - 07:47
    +3

    Ombudsman won't get involved until you go through the Bupa internal review process and they reject that.

  • screensaver on 24/07/2020 - 06:07
    +1

    I noticed this one day at a health insurance review site. There were a number of complaints of health funds doing this. I will see if I can find it

  • screensaver on 24/07/2020 - 06:57
    +2

    Worst overseas visitor cover
    published 1 year ago
    Don't get ripped by BUPA OVHC. The policy wording will say that it covers hospital care and OPD, but everything will fall apart when a claim will be made. The claim department tries to get everything under the pre existing umbrella so that they don't have to pay any money to the insured. It's an insurance meant for ripping and not for health protection.

    This is a review I found on product review/, there are 571 negative reviews, some of them about overseas visitors cover

  • screensaver on 24/07/2020 - 08:19
    +2

    Be sure to add your own review to add to the list

  • Moderatormoocher on 05/08/2020 - 09:19

    OP has resolved the issue, thread will be closed.

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