VHI rejected pre-approved claim

Gatica

I had an accident while abroad, and was brought to a GP surgery for x-rays to make sure there was no bone fracture. I called VHI world assist directly from there. They tried to arrange payment directly to the practice but since VHI does not seem to pay right away but basically gives a guarantee, the practice did not accept it and insisted on a direct payment, which I did.
I was given a reference number and emailed the forms to complete on return to Ireland. I sent all this off the week I got back, and was amazed to receive a message from them saying I was not covered for that. This is although my VHI cover clearly covers emergency treatment abroad up to 100,000 and they were willing to pay them directly at the time, so why sudden change of heart?

What the hell is going on? and what can I do to get my refund which they promised they would do? Honest to god, it seems they're a pain to deal with these days.

D3PO

how about you pick up the phone and ask them why its not covered.

Perhaps the bill isnt above the excess, perhaps you dont have a&e cover, perhaps the reason for injury isnt covered e.g skiing could be a million different things.

Ultimately if your not happy with the repsonse lodge a formal complain and if still not happy then go do the regulator with your complaint. Howver if you have lodged a claim and its been rejected most of the time theres a valid reason for it.

Gatica

I did, still waiting for a reply... Their response time at the mo is up to 2 days I believe, so just wanted to check in the meantime if anyone else may have experienced something similar. I was kinda hoping to pay off the credit card sooner rather than later...

igohugo12

I've had similar issues with them. I was told that my claim was not sucesfull coz my admittance for a ct was not a medical necessity as it could have been covered in out patience. Even though I had fallen off a horse and had a possible neck fracture. I ended up in a&be at 8pm and after an X-ray which showed a blur the doctor advised me in needed a ct and warned me of the possibility of being paralysed. Although the doctor clearly states that it was necessary to admit me according to vhi's medical opinion it was not necessary for me to be admitted to wait on a ct as I could have left a&e and come back the next day. So now I'm out 400€ ??? Aviva here I come

Gatica

That's awful! Sorry to hear that.
Well, I lodged a review and asked why it wouldn't be covered considering on the phone they were prepared to pay up front. They're still investigating... I'll give it another week and then call them to see what the progress is on this procrastination I mean investigation. After several years with VHI, I'll be changing too.

Oral Surgeon

igohugo12 wrote: »

I've had similar issues with them. I was told that my claim was not sucesfull coz my admittance for a ct was not a medical necessity as it could have been covered in out patience. Even though I had fallen off a horse and had a possible neck fracture. I ended up in a&be at 8pm and after an X-ray which showed a blur the doctor advised me in needed a ct and warned me of the possibility of being paralysed. Although the doctor clearly states that it was necessary to admit me according to vhi's medical opinion it was not necessary for me to be admitted to wait on a ct as I could have left a&e and come back the next day. So now I'm out 400€ ??? Aviva here I come

What makes you think that Aviva is any better.

I have a lot of dealings with the medical insurers and can confirm that in the past year they have clammed up and are paying nothing...

Gatica

It's crazy that they are "paying nothing" though, considering their contract with you as a customer has a list of things they should be covering and paying for. How can they be getting away with this??

igohugo12

Gatica wrote: »

That's awful! Sorry to hear that.
Well, I lodged a review and asked why it wouldn't be covered considering on the phone they were prepared to pay up front. They're still investigating... I'll give it another week and then call them to see what the progress is on this procrastination I mean investigation. After several years with VHI, I'll be changing too.

If u get no joy from them contact the health insurance authority and the the financial ombudsman who can take your complaint further. Also all their calls are recorded and u are entitled to a copy of these calls at any time. They may apply a apply a small fee for this bit if it helps ur case it's worth it. Hope it works out for u

Gatica

After they declined paying for my bill, I received a further 2 bills for ambulance/transport fees, which I forwarded to world assist. They got processed and paid within a few weeks (World Assist 1, VHI 0).
This was while my own refund was undergoing investigation, which I requested after they rejected my claim.

As an update, now 3 months later I finally got a cheque in the post! I don't know though if that was the result of the request for investigation or the fact the VHI and Laya were doing their "corporate" stands at work and I complained to the lady at the VHI desk about my rejected claim. She asked me to forward her the details of my claim and said she'd look into it.

igohugo12

Oral Surgeon wrote: »

What makes you think that Aviva is any better.

I have a lot of dealings with the medical insurers and can confirm that in the past year they have clammed up and are paying nothing...

I know it's a year later. But just wanted to say thanks for the advise. Decided to stay with vhi. I fought tooth and nail with them over my claim, I found a glitch in their term and conditions and use it to prove my case. Took some time and a 6 page letter of complaint but got my claim paid and 200€ comp. moral of the story,,, always read the t&c's