Details About the Private Health Insurance Ombudsman

Mark Benson

Mark Benson

Money Savings Advice Private health insurance ombudsman

As the popularity of private health insurance continues to grow, so we are seeing more referrals to the Financial Ombudsman Service. If you have any complaints regarding your private health insurance, you should contact your insurance provider first.

The next port of call is the Financial Ombudsman Service which covers individual health policies, group policies and other healthcare-related insurance.

The Financial Ombudsman Service covers an array of different business sectors which includes private health insurance. While the Internet has opened up the private health insurance market to everyone, it has led to misunderstandings and disagreements.

While very often these are worked out between the client and the insurance provider, sometimes they will require the assistance of the Financial Ombudsman Service.

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What Does the Financial Ombudsman Service Cover?

The UK financial services industry is absolutely huge, taking in an array of different products and services. It will be no surprise to learn that private health insurance is part of the remit of the Financial Ombudsman Service.

This takes in all different variations of private health insurance policies such as individual policies, group policies, cash plans, dental policies, six-week plans and international cover.


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Where Should I Report My Complaint?

If you have a complaint, the ombudsman will request that you approach your provider to give them the chance to respond. It may be a complete misunderstanding, mis-selling or a simple mistake.

In reality, the vast majority of complaints will be addressed in a positive manner by private health insurance providers. However, you will always have recourse to the Financial Ombudsman Service if you still have issues after speaking to your insurance provider.

What Are the Common Complaints to the Financial Ombudsman Service?

The Financial Ombudsman Service receives numerous complaints with regards to private health insurance, but the most common revolve around:-

  • Late payment of a claim
  • Refusals to cover the cost of treatment
  • Limited cover for particular ailments/injuries

As life expectancy in the UK continues to improve, we can probably expect more complaints to the Financial Ombudsman Service on pure volume of policies alone.

What Should I Do if I Was Mis-Sold a Private Health Insurance Policy?

We have seen numerous mis-selling scandals over the years, including PPI, which cost the UK banking industry billions of pounds. There have been instances of private health insurance being mis-sold with customers not realising the limitation/restrictions on cover for various ailments.

Unfortunately, some customers have been advised they were covered for “everything” only to find this was not the case. If you believe that you have been mis-sold a private health insurance policy, then you should complain to the insurance company first of all.

Then take your complaint to the Financial Ombudsman Service if you do not receive an appropriate response.

I Wasn’t Aware of Certain Conditions With My Policy, Can I Complain?

There will be occasions where questions were not asked, guidance was not given, but the details of limitation/restrictions are mentioned in the documents small print. It is the customer’s obligation to read the conditions and the small print associated with any financial product.

If the details were there, but you failed to read them, then it is unlikely you would be able to pursue a claim against the insurance company. If you were specifically advised of certain conditions which turned out to be wrong, then this is a whole different issue.

Should I Deal Through a Private Health Insurance Broker?

As the private health insurance industry becomes, more complicated many people are now choosing to find the most appropriate policy for their situation with the help of insurance brokers. While there will be a direct/indirect commission payable to the insurance broker, they have the experience, advice and contacts to get you the best deal on offer.

In many ways, this places the onus on the insurance broker to make you aware of restrictions and limitations per policy. In the event that you were not made aware of these issues, then you may be able to complain to the Financial Ombudsman Service.

Will I Receive Compensation if My Claim Is Upheld?

If your claim is upheld by the insurance company, insurance broker or the Financial Ombudsman Service, then you may be entitled to compensation. Some of the more common scenarios in which compensation is paid include:-

  • Delay in processing a claim resulting in NHS treatment
  • Rejection of a claim which was perfectly valid
  • Delayed authorisation of treatment resulting in additional complications

There are many more scenarios where you may receive compensation as a consequence of actions taken or not taken by your insurance provider/broker.


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My Application Form Was Incorrect Now My Cover Has Been Terminated

When applying for private health insurance, you will receive an application form which will ask a number of questions regarding your lifestyle and medical history. It is vital that you are upfront and honest regarding all aspects of your life and in particular medical history and any pre-existing conditions.

Failure to disclose these during the application process could result in the policy being terminated. The insurance company is perfectly within their rights to take such action if you failed to disclose all information requested.

Where Do I Complain About the Private Hospital Facilities?

If you have issues regarding the private hospital facilities where your treatment was carried out, then you should contact your insurance company in the first instance. They will discuss your situation with the private hospital, and where applicable you may receive a degree of compensation.

However, if you are not content with the response to your complaint then depending on the severity you may be able to take it to the Financial Ombudsman Service. The vast majority of claims will be resolved without involving the Financial Ombudsman Service, but the service is always there as a final adjudicator.

Summary

Private health insurance is part of the remit of the Financial Ombudsman Service and your last port of call if you are unable to resolve your complaint. While the vast majority of complaints are resolved between the customer, insurance company/broker and private hospital, sometimes this can be difficult if not impossible.

On occasion, the Financial Ombudsman Service may award a degree of compensation to the customer if the complaint is upheld.

Quick Private Medical Insurance FAQs


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How Can Money Savings Advice Help You With Private Medical Insurance?

Here at Money Savings Advice, we have partnered with some of the UK’s leading Private Medical Insurance companies. They have already helped thousands of people get the best PMI cover, and, they can do the same for you.

Choosing an independent adviser means they won’t recommend a policy unless they are sure it is in your best interests. Their advice is also regulated by the FCA, which gives you an additional layer of protection.

If you would like to speak to one of these brokers, then click on the below and answer the very simple questions.

Money Savings Advice Author Mark Benson

Mark Benson

Mark has been writing professionally for over ten years for the financial sector. Having started in the financial world as a stock-broker in central London and then moving to equities trader Mark is one of our senior financial writers who has a vast knowledge of multiple financial sectors.

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