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I had private medical insurance as part of my employer, I rang up in October for an appointment and one was "authorised" for January.

I then left my job in December and still attended in January. (I wrongly thought I'd be charged if I didn't attend and that as it was authorised this was fine...)

However, as I left my employer my insurance was void and I've been hit with a £500 hospital bill for a 15 minute appointment.

When I attended the appointment I signed a form that basically said if my insurance doesn't cover the cost I will have to.

My question though centres around signing a "blank cheque" - are they legally able to chase me for whatever figure they choose??

When I signed the form I had no idea how much the costs would be. Surely they have a role to inform me before the event? I kept thinking to myself if I had a MRI done I would be bankrupt.

Do I have a case to fight this in some way?

I took my insurance to the ombudsman but as this took 15 months to gain a response, I've also been hit with the "interest" for this period.

Any advice would really help..


Update: The ombudsman advised that the insurance company didn't have to pay out as within their terms it said if I leave the policy is void.

  • I am mindful that you are new to Law SE (welcome, BTW). Going forward, if you update your question after an answer has been posted, please notify the author of that answer. Many of us post our answer and don't usually keep track of whether an OP edits the question thereafter unless the OP notifies us. That would have obviated much of the vexation by another user in this post. Your update evidently went unnoticed by him as well, since he brought it to my attention just now. Regardless, hope your matter gets solved one way or the other. – Iñaki Viggers Dec 8 '19 at 12:36
  • Sure, i'll tag the author in future, i wasn't sure the best way to update this. – Adam Dec 16 '19 at 9:10
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Prior to OP's update of the question ...

Do I have a case to fight this in some way?

Without knowing whether UK legislation has a superseding provision in this regard, you seemingly have a meritorious position from the standpoint of contract law.

Your employment provided medical insurance as a benefit, [I assume] you accrued that benefit, and sought to use it while you were still employed there. To the extent that the delay in enforcing that benefit is not attributable to you (but to others such as the employer, the insurer, or the physician), the bills resulting strictly from that appointment are to be covered by whoever would be responsible therefor had the appointment occurred shortly after you requested it.

A contrary conclusion would imply that an employee's entitlement to accrued benefits is ultimately contingent on someone else's acts or omissions. That implication would generally encourage negligence --or perhaps deliberate obstruction-- in the performance of contracts.

The accrual & entitlement argument would fail if this sort of contingency were reasonably outlined in your contract(s) with the employer, insurer, or service provider. That being said, the form you were asked to sign during the appointment does not appear to inform you of that contingency.

You did not specify what the ombudsman responded. That information could shed more light on the legal merits of your position.

Upon OP's update/supplement of information ...

Do I have a case to fight this in some way?

No. The terms of the policy as outlined by the ombudsman are decisive (this is in line with one of my comments). I'm assuming that the ombudsman reading of the policy is accurate.

Moreover, the form you signed at the appointment reinforces the hospital's position that you are responsible for the expenses ensuing from the appointment. Signing that form placed on you the burden of first ascertaining an estimate of the expenses, it being the case that you knew --or should have known-- that you were no longer covered by policy.

These two last reasons --whether taken together or separately-- are likely to outweigh the merits of arguing that your appointment was delayed by having it scheduled for months later (see the initial version of this answer).

Proving that the bill is egregiously high in comparison with similar scenarios might be the only argument that could lead to a reduction of the bill, although this seems to be a stretch. Other than that, there is nothing you can do to reasonably dispute the bill(s) and surcharges.

That being said, I am keeping the initial version of my answer [that is, from prior to your update] because that rationale will guide others on how to assess akin scenarios where the issue is not determined by the terms of the policy or contract. Also, this showcases how leaving out one piece of crucial information can lead to the opposite conclusion.

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  • I don't think that medical insurance is an accrued benefit. Accrued benefits are benefits that accrue (add up) over the duration of employment, such as Paid Time Off. Not that it really matters. You're bunching up the employer and the insurer here, but it appears that the case would be against the insurer. It only matters if and when he was insured, not why. – MSalters Nov 28 '19 at 11:44
  • @MSalters Whether accrued or earned, the OP was entitled to a benefit as part of a compensation package. I agree that generally speaking the OP might have to go after the insurer, but it is unclear to me whether by "authorised" the OP meant another entity or whether the employer had a role in canceling the coverage for the delayed appointment. – Iñaki Viggers Nov 28 '19 at 11:55
  • I'd think that insurance ends when the employment ends. Canceling the policy cancels the authorization. I don't knows uk law but it seems absurd that this answer would be correct. – Andy Dec 1 '19 at 0:49
  • @Andy That sort of retroactive cancellation of delayed coverage seems impermissible unless coverage was procured fraudulently. There is no indication of fraud in the scenario the OP describes. There is merely a delay --presumably by some third party-- on enforcing a benefit to which the OP was already entitled insofar as he/she was still employed there. Your premise that "canceling the policy cancels the authorization" would encourage certain obligors to delay matters with hope that in the meantime their obligations will extinguish circumstantially. – Iñaki Viggers Dec 1 '19 at 11:33
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    Yet i knew your answer was wrong before that update because i know your take in the delayed benefits was nonsense, because that's just not how insurance works, ever. No insurance will pay for something that happens when a policy is not valid, but you made up this delayed benefits reasoning to say the op could have a valid legal claim, when he never did. – Andy Dec 8 '19 at 12:48

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