Private health insurance claim
Discussion
I have a private health care package provide from my employer. I have added my wife and children to this package.
In July this year, my son broke his arm while playing in the garden. We got him to A&E at about 9pm where we waited and waited for many hours before eventually having some x-rays and they decided he needed an operation to manipulate and pin the joint. We were admitted to the ward at 3:15am. Later that morning he had his operation and the surgeon advised he need to stay a second night. He was discharged at 11am the following morning.
My private health care package provides a cash benefit for NHS treatment. They pay a fixed price of £250 per night spent in an NHS hospital. The question I have is how many nights did we spend in hospital?
My opinion is that we arrived at the hospital at 9pm and left two days later at 11am so that is two nights. My son went to bed twice in hospital, woke up twice in hospital and was served two breakfasts in hospital. The other way to look at it is that he did not sleep in his own bed for two nights.
The health care company is claiming that because he was admitted to the ward after midnight, the first night does not count. They will therefore only pay for the second night.
I've copied the only relevant terms from the policy documents here:
In July this year, my son broke his arm while playing in the garden. We got him to A&E at about 9pm where we waited and waited for many hours before eventually having some x-rays and they decided he needed an operation to manipulate and pin the joint. We were admitted to the ward at 3:15am. Later that morning he had his operation and the surgeon advised he need to stay a second night. He was discharged at 11am the following morning.
My private health care package provides a cash benefit for NHS treatment. They pay a fixed price of £250 per night spent in an NHS hospital. The question I have is how many nights did we spend in hospital?
My opinion is that we arrived at the hospital at 9pm and left two days later at 11am so that is two nights. My son went to bed twice in hospital, woke up twice in hospital and was served two breakfasts in hospital. The other way to look at it is that he did not sleep in his own bed for two nights.
The health care company is claiming that because he was admitted to the ward after midnight, the first night does not count. They will therefore only pay for the second night.
I've copied the only relevant terms from the policy documents here:
Policy Documents said:
15
If you are admitted free of charge on the NHS for treatment
or tests that we would have paid for as a private patient, we
will give you £250 for:
• each admission you have as a day-patient
or
• each night when you are an in-patient.
We will not pay NHS cash benefit for out-patient treatment
(for example radiotherapy), or for treatment that we would
not pay for as a private patient (for example rehabilitation /
convalescence, or an admission for treatment of a
pre-existing condition or a chronic condition).
Definitions
In-patient
A patient who is admitted to hospital and who occupies a
bed overnight or longer for medical reasons.
Am I in a no-win battle here? Should I just accept this as a lesson in life to never trust insurance companies and move on?If you are admitted free of charge on the NHS for treatment
or tests that we would have paid for as a private patient, we
will give you £250 for:
• each admission you have as a day-patient
or
• each night when you are an in-patient.
We will not pay NHS cash benefit for out-patient treatment
(for example radiotherapy), or for treatment that we would
not pay for as a private patient (for example rehabilitation /
convalescence, or an admission for treatment of a
pre-existing condition or a chronic condition).
Definitions
In-patient
A patient who is admitted to hospital and who occupies a
bed overnight or longer for medical reasons.
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