Complaining About Private Health Insurance

In previous years there seemed to be a lot of press attention on individual clients who were unhappy with the way their health insurance companies dealt with their claims. Guidelines published by the Association of British Insurers (ABI) introduced fairer ways for medical insurance companies to deal with problems that resulted from claim disputes and this has resulted in fewer complaints and more satisfied customers. However, if you are unhappy with any aspect of your dealings with your private medical insurance company you are entitled to complain.

Your medical insurance company
The first step is to formally write to your insurer, outlining the exact nature of your complaint.

All medical insurance companies are obliged by law to have a complaints procedure in place. This should be fully visible in your policy document and should include a contact telephone number, email and address of the department you need.

Each company will vary in its complaints procedure and it is important that you familiarise yourself with your insurers' information. PruHealth, for example, try to resolve your complaint within 8 weeks. If they cannot do this then they are obliged to write to you to explain why they have not been able to do this and advise you when they will be contacting you again.

The complaints procedure for Freedom Health Care includes acknowledging your complaint within five days and responding fully to it within a maximum of twenty-eight days. Where this is not possible they commit to writing to you to let you know why they have not been able to resolve the matter and when they will contact you again.

If your health insurance provider has not been able to satisfy your complaint your next step is to contact a financial ombudsman.

Financial Ombudsman Service (FOS)
Your medical insurance company is obliged by law to advise you that if they cannot resolve your complaint that you can contact the financial ombudsman. They must give you the contact details of this service.

The Financial Ombudsman Service is a free and independent service. They will look at the evidence provided by you, your insurer and your doctors and assess your case. They take into account: 'terms of the contract, the law, good industry practice and the regulator’s rules.'

The main reason for the complaints they receive are about:

-limits on benefits because, for example, the insured person was not treated at a designated hospital
-the exclusion of claims because the insurer has deemed a condition to be ‘chronic’ and therefore no longer covered
-the exclusion of cosmetic and other treatment
-the application of exclusions for experimental or unproven treatment

Complaints about non-disclosure in medical insurance claims are also common but have declined since the introduction of the IBA's non-disclosure policy.

The contact details for FOS are:

The Financial Ombudsman Service
South Quay Plaza
183 Marsh Wall
London E14 9SR
Telephone: 0845 080 1800
Email: complaints.info@financial-ombudsman.org.uk
Website: http://www.financial-ombudsman.org.uk/