Private Medical Insurance. Experimental Treatments Could Now Be Covered.

Private medical insurance policies can be very particular about what they do
and don't cover. For example, if you are insured with Bupa, then you will
only be covered for experimental medical treatment if it is part of a bona
fide medical trial or study. And Norwich Union Healthcare stipulate that
treatment is only covered if it is considered to standard practice in the
UK.

So what happens if your doctor recommends that the best course of action
would be to have a newer type of treatment, rather than a long established
standard procedure? For the sake of your health, you will probably be
wanting to take your doctor's recommendation. However, many private medical
insurance policies simply do not allow for this.

The issue has come to light as a number of people have been recommended
experimental treatment, only to find that the insurer will not cover it.
These people complained to the Financial Ombudsman Service (FOS) who, in
some cases, rules against the insurers. One of the treatments that has
emerged as something that should be paid for is a new form of varicose vein
surgery. Standard practice in the USA for the last five years, insurers in
the UK were refusing to pay out until the FOS made their decision.

A type of larynx surgery which is performed by laser is also now to be
insured, as is bladder surgery carried out by keyhole rather than through an
open wound, and a new type of spinal treatment which means vastly reduced
side effects.

However, the FOS has only been able to overturn insurer's decisions on
policies in which experimental treatments are not specifically stated in the
policy as being excluded. The Ombudsman can't do anything about those
policies that do specifically exclude experimental treatments.

The FOS has pointed out that just because they have ruled against the
insurers, it doesn't mean they are endorsing specific types of treatment.
They also said: "If the policyholder has been advised by his or her treating
physician that, in their particular circumstances, they should have a newer
treatment instead of an established procedure, our general view would be
that it could be unfair for the firm to turn down the claim entirely."

As a result of these recent rulings, insurers may well reconsider how they
deal with experimental treatments in their policies. Insurers say that they
act in the best interests of their customers, and if they are asked to fund
something that they consider to be against the best interests of the
patient, then they will reject the claim. However, one insurer, WPA, has
admitted that if the customer's doctor does recommend a particular course of
experimental treatment, and there is a very good reason why that treatment
is better than any other, then they will pay out. Norwich Union Healthcare
has already said that they will be reviewing their policies in the light of
the FOS' rulings. As for Bupa, it has expressed concern that customers will
be claiming for procedures or drugs that have not been fully tested in the
UK.

At the moment, it's a case of 'watch this space'. If you are thinking about
getting private medical insurance, then keep this issue in mind when you
choose your policy. It would be very frustrating to be recommended a
treatment, and then find that you are not insured for it. Remember to check
out the Internet first for the cheapest policies, most private medical
insurance policies offer a lot of advice and information on which policy is
best suited to you, which can be very useful with all the choice out there.

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