Bupa

Complaints

A complaint was raised with Bupa on the 4th April via Web. See letter below. Dear BUPA Customer Service, I am writing to express my disappointment and frustration regarding the failure of BUPA Health Insurance to cover my infant son, Fionn Gilsenan, under my policy. I have been a loyal BUPA member for over a decade, and it was with great surprise that I learned that I needed to inform BUPA about the birth of my son in order for him to be added to the policy. Despite being a longstanding member, this crucial information was not communicated to me at any point during my tenure with BUPA. To provide context, on the 21st August 2023, Fionn was referred by his General Practitioner, Dr. Syed Ahmed, to see an Ears Nose and Throat specialist for an opinion and management regarding his ongoing cough over two months and recent ear infection with ASOM & Purulent discharge from both ears. Subsequently, on the 31st August 2023, Fionn was referred by his General Practitioner, Andy Shen, to see an Ears Nose and Throat specialist as his condition worsened. Realizing the necessity of comprehensive coverage for my family's healthcare needs, I promptly upgraded my policy to Corporate Silver Plus Mid Hospital $500 Excess with Corporate Budget Extras Family on the 14th September 2023. This update explicitly included my partner, Ana Otene, and our son, Fionn Gilsenan, who was then 10 months old. On the 15th September 2023, Fionn was seen by Dr. Dan Gordon, who prescribed a steroid nasal spray (Avamys Nasal Spray 27.5cg) in the hope of shrinking the adenoids and reducing the pooling of fluid in his middle ear drum. On Fionns third appointment with Dr. Dan Gordan on 23rd Feburary 2024, he was referred to have grommets installed in both ears (procedure numbers 41632 x 2 and 41764). After calling BUPA later that day I was informed that BUPA would not provide any cover for Fionns procedure due to his cover date starting on the 14th of September. It is my contention that under the Insurance Contracts Act - Section 54, BUPA was not at a disadvantage by not being informed about Fionn's birth and therefore adding him to the policy. Given that he would have been free of charge to add to either my previous policy or my current policy from birth, there is no valid reason for the denial of coverage. I urge BUPA to reconsider its decision and provide coverage for Fionn retroactively, as it is both fair and in accordance with the principles of equity and integrity. Additionally, I request clarification on any relevant policies or procedures to ensure that such oversights do not occur in the future. I look forward to your prompt attention to this matter and a satisfactory resolution. Sincerely, Louis Gilsenan