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James

Experience with AXA PPP (British Medical Insurer)

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I have a private health scheme through work which I have used a lot over the past couple of years and have just been diagnosed with POTS, PPP have been really good and paid for everything up until now. I have seen maybe 15 doctors, had numerous tests and a few hospital stays. I have been under the care of Prof. Mathias at both St. Mary's and The National. I received a letter from PPP today stating they have paid for my most recent hospital stay and tests, but they will not carry on paying Prof. Mathias's fees as they feel they are excessive. I have just spoken to them on the phone to clarify the situation and they have offered to pay the first ?110 of any consultation and I would have to make up the short-fall. So far when I have seen him, his fees have been ?325 and ?255 respectively, but this means I will have to find up to ?215 for each visit from now on. Just to put this in perspective, they have happily paid ?262 each time (about 7 or 8 visits) I see my local ENT doctor, yet they are refusing to pay ?255 for me to see one of the top neurosurgeons in the country. I have no problems with the NHS, but for example their waiting list for a Tilt Table Test was 10-12 months and I just couldn't wait that long. I fully intend to fight their decision and am aware of their complaints procedure, but does anyone have any tips on getting them to pay?

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Hi,

I don't have any tips on getting your insurer to pay up but just wanted to let you know that I too was told by my doctor it would take 9 months to get an appointment for a tilt test.So I decided to get an appointment in a private clinic which cost ?100 for the single consultation.That consultant then told me to come along to his NHS clinic the following week where he referred me for a TTT and it only took 4 months this way.Just wanted to let you know it can be done a bit more quickly in case you wanted to get the test done while waiting on a decision from your insurers.I hope your fight with the insurers goes well-its a pity they're always trying to look for ways out of paying up what they owe.

Dee

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Sorry, I wasn't very clear in my first post, I've already had the TTT done through PPP (was just over a month wait) and have been diagnosed with POTS. It is my ongoing care under Prof. Mathias they are refusing to fully pay for. I was using the TTT wait time under the NHS as an example of why I'd rather continue my treatment privately.

If I was working I wouldn't mind so much, but I have been off work for about 8 months now and have been on half pay for the past 2 months, which makes things a bit tight.

It just seems like I'm making some progress with my condition and then another hurdle gets put in the way.

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