Tom contacted us when his insurer agreed to cover only half of the cost of his emergency surgery abroad.
Tom had emergency surgery abroad. He didn’t contact his insurer first and used his credit card to pay the £3,000 bill he was given when he was discharged.
When he got home, he made a claim to his insurance company. But the insurer would only reimburse £1500 as it said it would have been able to negotiate a reduced fee with the hospital if it had paid the bill directly.
Tom thought this was unfair and made a complaint to his insurer. Unhappy with the outcome, he decided to get in touch with us to make a complaint.
What we said
We thought it was understandable that Tom hadn’t contacted his insurer first as the surgery was an emergency. But we did think Tom should have told his insurer before he paid his bill – because his insurer would then have paid the bill directly.
We asked the insurer to show us the saving they said they would have made if they’d had the chance to negotiate a fee with the hospital. They provided a statement from their cost-containment team that explained on average they negotiated bills from this hospital down by 50%.
We felt the insurer’s offer was fair, and we didn’t uphold Tom’s complaint.
Related case studies
Consumer complains about insurer's handling of claim after bad experience on flight
Amin wanted an insurance refund after his cruise was cancelled