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Can an operation be refused with private health insurance? |
I'm considering using my Bupa Private Health Insurance to sort out a reoccurring problem with tonsillitis. I've decided that I would rather have them removed altogether and be done with it forever as I've had them 5 times since nov last year. Can the consultant refuse to take them out or do they have to accept my wishes? Sounds like you have two questions...first, can your Ear, Nose and Throat specialist refuse to remove your tonsils without good medical cause. The answer is yes, regardless of what insurance plan you have, if the physician doesn't feel that it is medically warranted, or would in some way be harmful to remove the tonsils, they can refuse to do the surgery. If you disagree with his/her determination, you have the option of seeking a second opinion. There is also the matter of your insurance company refusing to pay for a surgery that was not considered "medically necessary" according to their guidelines. It would be important to know if they consider the tonsillectomy "elective" if your doctor does not support you in your decision to have them removed. Good luck in your efforts to get help! Source(s): Health care worker for many years. correct go to another doctor maybe the fee is not good, maybe too much risk maybe its not the solution they can do whatever they want to... Yes on both. The insurance company can refuse to pay if it feels surgery is unjustified. Each policy has limits, often related to the cost of the premium. Often religious based employers specify that they will not include birth control or other procedures which may conflict with the teachings of the church when they provide health insurance. A physician can refuse to operate if he or she does not feel the surgery is medically justified and the patient's life is not threatened. Surgeons are regularly reviewed by insurance companies to be sure that they are not doing unneccesary surgery. |
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