We were insured by PruHealth through a company policy. During the year we were insured with them I had two operations – the second to correct a mistake made in the first.
We generally received good service, until the company policy was moved to another insurer in January.
Unfortunately I had some outstanding bills from the time we were covered by the Pru. The first was for a brace that I had to wear 24 hours a day for six weeks after the operation. The surgeon would not have done the operation without this equipment. This bill was for £363. The second bill was for the follow-up appointment six weeks later; this was approved at the time of the operation.
When I got to the hospital, the appointment, unknown to me, was with my surgeon's associate, another consultant orthopaedic surgeon. This bill went unpaid too and it was for £180. I have paid both bills in full.
I've written to PruHealth twice with all the relevant information, but not only have they not paid either bill, they haven't even had the courtesy to reply.
I am not sure whether they think they need not deal with the matter because we are no longer insured with them, or because they have turned down both claims. Either way I would have appreciated some feedback. BL, Henley-on-Thames
PruHealth puts this problem down to "communication going astray on both sides". It admits it caused an "unacceptable delay" by not responding to three of your letters in February and March. But it says you overlooked emails it sent you about your claim. You say you were so bombarded with marketing emails from the Pru that you did eventually stop opening emails from them – and that the information request it refers to could have been in one of these.
It then claims it rejected your £180 claim because you had seen a different specialist for the post operative follow-up consultation than the one it had approved, which it says should have been pre-authorised.
In any case, the important thing is that PruHealth recognises its own failings in this case and has agreed to reimburse you the £180.
As for the £363 bill, PruHealth says a brace would not usually be covered under the terms of the policy but that, because it was an integral part of the surgery, it will reimburse you the money as a gesture of goodwill. It has contacted you to apologise directly and you are happy with the outcome.
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