FOS Health Insurance Complaints

The Financial Ombudsman Service (FOS) published its public complaints figures this month. But are they valuable and what do they tell us about complaints made about medical health insurance?

If people are unhappy with their health insurance company they have to follow the company's official complaints procedure and if they are still not satisfied they can appeal to the independent FOS who will make a final decision in each case.

The statistics collected for insurance include different types of insurance including private medical insurance as well as critical illness insurance and income protection therefore there is not an easy comparison. However out of all the insurance complaints they received 70% were upheld. This is a large percentage and means that 7 out of every 10 complainants had not received fair treatment from their insurance company.

Individual companies were named although again it is hard to compare as different types of products were being scrutinised.

Complaints Upheld
Bupa - 25%
Aviva Health UK - 36%
AXA PPP Healthcare - 44%

Maggie Craig, director of consumer strategy at the Association of British Insurers (ABI), said:

'It’s absolutely right that consumers should know about the performance of firms who look after their insurance and investment needs, and complaints handling is an important part of that. But any such data must be presented in a way that helps consumers make informed choices.

'Unfortunately, the way that the FOS has chosen to present the data doesn’t achieve this aim, and may in fact mislead consumers about the performance of individual firms. For example, consumers can’t compare performance by sector or by product.'

Even though comparisons between figures may be misleading it must provide an extra incentive for the private medical insurance industry and individual health cover providers to look at their complaints statistics and procedures and see where they are going wrong.

More transparency is what some quarters are looking for. Critical illness insurance providers, for example, have to declare their claim rejection figures every year. Transparency enables solutions to come quicker even though it may be painful for a company to expose its results to the general public.

The complaints figures for this year were almost the same as last year which is a good sign. Since 2005/6 complaints have come down from 2,291 to 1,874. The ABI's work on improving non-disclosure is one of the reasons for this reduction.

According to FOS one area where they still receive complaints is in health insurance cases where consumers received reveiwed premiums which they feel are unfairly steep. Their website states:

'We continue to receive complaints from consumers who have entered into so-called "reviewable" insurance policies, where the insurer has the right to review the premium at intervals of five or ten years. These disputes generally involve reviews that have been carried out after many years – and have resulted in a significant increase in the premium.'

Unfortunately FOS does not publish the results from companies who have had less that 30 complaints. F0r a small company this may represent a large number of complaints and it would be good for the public to have this kind of information available to them.

Reconstructive Surgery for Breast Cancer

Some women who develop breast cancer have to go on to have a mastectomy. For many women this is not just a frightening medical matter but one which affects their self image and self esteem. Reconstructive surgery is an option for many women but recent evidence shows that this is not always offered on the NHS. Alternatively companies that offer health insurance for cancer will give you the peace of mind that you can have reconstructive surgery if you wish.

Statistics from the NHS Information Centre and Royal College of Surgeons indicate that in 2007-08 only 48% of women with breast cancer were offered reconstructive breast surgery.

Dr Chris Caddy, consultant plastic surgeon at the Sheffield Teaching Hospital NHS Foundation Trust said:

'There is a shortfall in access to breast reconstruction. We’re carrying out the audit to find out what the level of service is and where the shortfalls are.

It’s partly down to a lack of resources, the information given to women, and the options offered by the breast- care nurses who help create patient-care plans.'

The 2009 National Mastectomy and Breast Reconstruction Audit showed differences between NHS and private medical care. In the Independent sector, for example women having mastectomies were treated more quickly and immediate reconstruction (those that take place straight after a mastectomy) rates in the independent sector were high.

Research also shows that there are regional variations too. Those with comprehensive health insurance for cancer however can get reconstructive breast surgery as part of their health care policy. Normally plastic surgery is not included in medical health policies but if you have a policy which includes comprehensive cancer care then this is not the case. In the UK Bupa, The Exeter Friendly Society and PruHealth provide this.

Bupa, for example offer reconstructive breast surgery after cancer in their Select Heart and Cancer Policy. Each policy is different however and the details need to be checked. The Exeter Friendly Society policy wording is as follows:

'Post-traumatic or post-surgical reconstruction to restore function or appearance is included if performed within 12 months of the injury or primary surgery. Breast surgery where the treatment is to correct disfigurement is included if it was caused by an accident or specific disease of the breast'

The PruHealth wording is as follows:

'Post-traumatic or post-surgical reconstruction to restore function or appearance is included if performed within 12 months of the injury or primary surgery. Breast surgery where the treatment is to correct disfigurement is included if it was caused by an accident or specific disease of the breast. For a Policy start or renewal date on or after 1 July 2009: We will pay for the initial reconstructive surgery to restore functional appearance following major trauma or cancer. Any subsequent related treatment will be covered if the treatment is intended to cure an acute medical condition'

One problem which can occur is that women can be uncertain as to whether they want reconstructive surgery or not until some time after their mastectomies but under current private health insurance policies they only have 12 months to make up their minds.

New International Health Insurance

Aviva have recently launched a new private medical insurance product for people who live abroad. International Solutions is a flexible plan that offers different options for Brits who live abroad.

In the UK we have a fantastic base level of care in the NHS and, bar a few charges, its free for all UK citizens but what about UK citizens who live and work abroad? Different countries offer different levels of health care and for those who want to ensure they keep receiving good care private medical insurance is a very attractive option.

International Solutions offer a comprehensive core policy with a variety of add-on options that will enable people to choose different modules including:

• Wellness, Dental and Optical
• Increased Out-patient
• Compassionate Travel
• Maternity

International Solutions is offered to both individual and corporate clients and cover costs vary according to where you are in the world. If costs are cheaper in one area then they are reflected in the premiums that you pay and if you are in a more expensive band you will also be covered in areas that are less expensive than yours.

Andrew Turner, Aviva’s head of international, said:

'As Aviva’s healthcare arm, we’ve a wealth of experience in the global market and recognise that healthcare provision differs across the world. With budgets tight, both corporate and individual customers need the flexibility to be able to tailor their medical insurance to suit their needs and to complement the healthcare provision in their country of residence.

Offering one of the widest choices of modules available in the market, International Solutions enables them to do just that. And, with additional benefits such as the medical information helpline providing topical information on anything from vaccinations to swine flu, we believe that International Solutions offers some of the most comprehensive benefits in the market.'

Premiums can be reduced in the following ways:

• Increasing excess
• Reduced Out-patient cover
• Reducing Additional Benefits

One interesting thing with International Solutions is that it includes a limited amount of cover for the maintenance of chronic conditions. Normally health insurance does not cover chronic conditions. This may give peace of mind particularly if you are new in a country and unused to its medical system.

Health Insurers use YouTube

Everyone is using YouTube and that includes health insurance providers. The growth in the appeal of video clips has been enormous over the last three years and health cover providers are making the most of this medium by publishing their advertising and information clips online. Below are a sample of what's available on YouTube:



The TV advert that was used to prepare British audiences for the change over from Norwich Union to Aviva is also available on YouTube:



AXA PPP Healthcare publish clips of their exercise videos on YouTube:



And this video is from their advertising campaign a couple of years ago:



Videos are great as they allow a company to communicate very directly with as. However, as with any other advertisement time should be taken to research the individual companies with a view to finding out both what they offer and what they do not offer. Remember in adverts companies are presenting their best side. As a consumer you need a more balanced view of what's on offer.

Yearly Health Insurance Premium

Lots of people are trying to cut down on the cost of their health insurance premiums. Most people pay for their health cover with a monthly premium that is calculated for you when you take out a policy. However some medical health insurance providers allow you to pay for the whole year upfront and for this they usually give you a discount.

AXA PPP Healthcare for example give a 5% discount if you pay yearly.

This is only one way that can help to cut your health insurance premium costs. Other ways include:

* The six week option
* Co-payment
* Restricted hospital lists
* Reducing your level of cover
* Using the cheapest health insurance

Bupa HM Forces Health Insurance

There are many specialist medical insurance products which are tailored to suit groups that have particular needs. Bupa, the UK's largest private health insurance provider, offer a specialist health insurance for HM Forces. The cover provided is offered at a 47% discount and includes the following:

• private medical treatment in eligible establishments
• the option to cover just your partner or your children
• access to private in-patient and day-patient treatment
extensive private cancer cover
• cover for injuries resulting from dangerous sports and military exercises
• complementary medicine
• psychiatric treatment after two years’ membership

The forces which are covered by this health insurance scheme are:

the Royal Navy, the Royal Air Force (RAF), the Royal Marines and the Army

It is important to note here that as members of the forces are often stationed abroad they will not always be able to be treated in a Bupa hospital or NHS hospital. In these circumstances Bupa will cover hospital stays up £200 only.

Another interesting aspect of this policy is that it appears to include cover for injuries arising from dangerous hobbies and self-inflicted injuries. It is very unusual for private medical insurance companies to offer these elements within their policies.

It is important to note that the Bupa HM Forces policy does not cover repatriation. Repatriation refers to the return of soldiers to their homeland. Also, the psychiatric treatment that they offer is discretionary and needs to be cleared by Bupa before the treatment goes ahead.

Bupa also offers dental insurance for HM Forces and MOD staff as well as health insurance for MOD staff at a 47% too.

Musculoskeletal Disorders Cause Absence

A recent study, Fit for Work Europe, shows that people who live in the EU are having to take a lot of time off work due to musculoskeletal disorders (MSD's). 49% of all absences and 60% of permanent work incapacity were accounted for by musculoskeletal disorders. Health insurance companies have been aware of working hours lost through these issues for quite some time.

Companies who provide their staff with health insurance are keenly aware that the sooner a problem is sorted out the quicker their staff members can return to work, not just healthy but also with more peace of mind.

The authors of the report say that the high levels of work absence is making Europe less competitive than America or China. They recommend that all bodies work together in order to reduce time lost at work but appreciate that this does not tend to happen:

'In many of the countries we studied - awareness, resources and political will are not yet at a stage where coordinated and effective early intervention is currently deliverable.

'The consequences of this lack of readiness may be far-reaching for workers with MSDs who want or need to retain contact with the labour market. Successful early interventions require clinicians, employers and the health care and social welfare systems to work together. This is rarely the case, even to achieve positive clinical outcomes. It is even less common to find that job retention or return to work is the goal.'

In the UK, earlier this year Aviva, a private medical health insurance company, launched a new product for its business clients: Back-Up. This product aims at dealing with back and neck complaints quickly in order to reduce time taken off by staff. It has been so successful that the product is now also open to individual private customers as well.

Back-Up customers are encouraged to call the Back-Up service where they will speak to a case manager who takes a full history of your problem and offers 'practical and clinical advice and support.' They can also work with the persons line manager to advise on how the person can be helped to proceed at work.

It is estimated that in the UK 9.5 million working days were lost in 2005-2006 due to musculoskeletal disorders. This presents a problem for the UK economy. Very often the NHS can do nothing for you. The problem is too widespread and they do not have enough resources. Private health insurance on the other hand can help to support a person much speedily and tailor-made schemes such as the Aviva one are even more useful as back conditions can often be chronic and are therefore sometimes not covered under normal medical insurance.