Contract question - private health
Discussion
Hopefully a simple question...
I used to have private health insurance via a former employer. My wife had treatment under it. There seems to have been some issue with his fee rates - Aviva has set rates per treatment, and the Consultant's invoice seemingly exceeded that.
There is still an outstanding sum. My cover has lapsed, and the Consultant is now seeking to recover this from me. I'm of the opinion that the contract is between the insurer and Consultant, rather than with me - am I correct?
I used to have private health insurance via a former employer. My wife had treatment under it. There seems to have been some issue with his fee rates - Aviva has set rates per treatment, and the Consultant's invoice seemingly exceeded that.
There is still an outstanding sum. My cover has lapsed, and the Consultant is now seeking to recover this from me. I'm of the opinion that the contract is between the insurer and Consultant, rather than with me - am I correct?
While I have no direct knowledge of Aviva's arrangements I would expect the contract should be between the consultant/hospital and the patient. Shortfalls of this nature can be a nightmare but my experience is that where an insurer is aware that this is likely they will have an undertaking from the consultant not to seek any underpayment from the patient as this reflects badly on the insurer.
Was the treatment, including the hospital and consultant, pre-approved by Aviva before treatment? If so I would expect them to warn the patient if they are aware that this scenario is likely to arise.
I appreciate that the cover is no longer in force but I'd be inclined, if you haven't already done so, to speak to Aviva.
Was the treatment, including the hospital and consultant, pre-approved by Aviva before treatment? If so I would expect them to warn the patient if they are aware that this scenario is likely to arise.
I appreciate that the cover is no longer in force but I'd be inclined, if you haven't already done so, to speak to Aviva.
Edited by KeithE on Wednesday 22 November 15:04
Bonefish Blues said:
Hopefully a simple question...
I used to have private health insurance via a former employer. My wife had treatment under it. There seems to have been some issue with his fee rates - Aviva has set rates per treatment, and the Consultant's invoice seemingly exceeded that.
There is still an outstanding sum. My cover has lapsed, and the Consultant is now seeking to recover this from me. I'm of the opinion that the contract is between the insurer and Consultant, rather than with me - am I correct?
Firstly I am not a lawyer, but I used to work in the industry. My understanding based on what my employers taught me is that the contract is between you/your wife and the consultant. The invoice will be to you/your wife which the consultant will have sent to your insurers to settle however, ultimately it is your responsibility to pay.I used to have private health insurance via a former employer. My wife had treatment under it. There seems to have been some issue with his fee rates - Aviva has set rates per treatment, and the Consultant's invoice seemingly exceeded that.
There is still an outstanding sum. My cover has lapsed, and the Consultant is now seeking to recover this from me. I'm of the opinion that the contract is between the insurer and Consultant, rather than with me - am I correct?
Regarding the insurers rates the consultant may or may not have their own provider contract binding the consultant to only charging the insurers agreed fees.
Aviva were one of the "better" insurers that would contribute to most claims assuming it was valid, covered by the terms of your policy, and had sufficient evidence to support it regardless of if the consultant/provider was on their recognised list or not.
KeithE said:
While I have direct knowledge of Aviva's arrangements I would expect the contract should be between the consultant/hospital and the patient. Shortfalls of this nature can be a nightmare but my experience is that where an insurer is aware that this is likely they will have an undertaking from the consultant not to seek any underpayment from the patient as this reflects badly on the insurer.
Was the treatment, including the hospital and consultant, pre-approved by Aviva before treatment? If so I would expect them to warn the patient if they are aware that this scenario is likely to arise.
I appreciate that the cover is no longer in force but I'd be inclined, if you haven't already done so, to speak to Aviva.
This is good advice particularly the last paragraph.Was the treatment, including the hospital and consultant, pre-approved by Aviva before treatment? If so I would expect them to warn the patient if they are aware that this scenario is likely to arise.
I appreciate that the cover is no longer in force but I'd be inclined, if you haven't already done so, to speak to Aviva.
My healthcare is pretty clear cut, they will repay up-to X amount.
Recently wife was booked in for a specialist consultation after she was unhappy with the NHS, Quoted £250 but the final bill only come to £150, we had to pay upfront and send the receipt to be imbursed, avoiding payment issues
Recently wife was booked in for a specialist consultation after she was unhappy with the NHS, Quoted £250 but the final bill only come to £150, we had to pay upfront and send the receipt to be imbursed, avoiding payment issues
Thanks all - I have spoken to Aviva.
It's a little more complicated than the average, but in essence they have said leave it with us. Brer Consultant signed up to our terms. You have paid your annual excess, all the treatments were pre-approved by us, at our rates, so you have no liability here.
It's a little more complicated than the average, but in essence they have said leave it with us. Brer Consultant signed up to our terms. You have paid your annual excess, all the treatments were pre-approved by us, at our rates, so you have no liability here.
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