Visa Denial Question

You said you had planned to do a fiance visa but then got pregnant. Does that mean you were in the UK for the whole 9 months of your pregnancy?

Start by contacting the hospital where you gave birth. Write them a letter explaining your situation and stressing that it is extremely important that they send you a bill. Emphasise that your future in the UK could be jeopardised if they don't. Chase them up. They need to provide you with SOMETHING that you can submit to UKVI.

Should I wait for an official denial? I feel like at this point I should wait and then seek legal advise.

Basically, they gave you the care because they'd hardly refuse a pregnant woman, but you weren't entitled to that care for free.

That's the issue here. They are not legally allowed to refuse treatment to a pregnant woman, but unless you're in the UK on a visa that allows NHS treatment, you will not be entitled to get that treatment for free.

See here: https://www.maternityaction.org.uk/advice-2/mums-dads-scenarios/3-women-from-abroad/entitlement-to-free-nhs-maternity-care-for-women-from-abroad/

NHS maternity care is provided free of charge to women who are;

- considered to be ‘ordinarily resident’ in the UK, or
- EEA nationals who are insured by another European state, or
exempt from charges (including people who have paid the immigration health surcharge).

If you do not fall into any of these groups you may be asked to pay for your care, but you cannot be refused care if you cannot pay at the time you receive care.  It is very important for your health and your baby’s health that you attend for maternity care even if you are unable to pay.

Maternity care includes all antenatal, birth and post-natal care.

Also, even if you had got the fiance visa you were planning on, you still would have had to pay for the birth, as people on fiance visas are also not entitled to free NHS care... you would have needed health insurance for the duration of the fiance visa, and then claimed back the costs of the birth later.

Should I wait for an official denial? I feel like at this point I should wait and then seek legal advise.

I wouldn't wait for a denial - I would get on and contact the NHS hospital and get on them to give you a bill.

It may be that instead of refusing the visa, Sheffield will contact you to ask you for proof of payment, so I would get that sorted out ASAP.

I wouldn't think you will need legal advice though. If the visa is refused, it will just be a case of having to get and pay the NHS bill and then applying for the visa again.

Just re-asking the question to be sure you're not dealing with an overstay as well as the NHS situation: Were you in the UK for the whole 9 months? Did you stay beyond the six month visitor limit?

Just re-asking the question to be sure you're not dealing with an overstay as well as the NHS situation: Were you in the UK for the whole 9 months? Did you stay beyond the six month visitor limit?

I was in and out of the U.K. so never overstayed. Does anyone have personal experience with a denial based on NHS use?

See here: https://www.maternityaction.org.uk/advice-2/mums-dads-scenarios/3-women-from-abroad/entitlement-to-free-nhs-maternity-care-for-women-from-abroad/

I was reading the information on the link provided by ksand24 and I found below very useful for the situation. So I guess the most prudent thing to do at this point is to contact NHS ASAP and get on a repayment plan.

It is important to talk to the NHS to agree a payment plan and try to stick to the plan. You can ask to repay in small instalments e.g. £5 per month instalments if you can show that this is all you can afford to pay. The guidelines say that information about debt may only be passed to the Home Office where no reasonable arrangements have been made, or kept to, for repaying the debt.

If you pay the debt after the Home Office has been informed or you agree a payment plan, the NHS must inform the Home Office immediately. The NHS may be liable for any consequences of failing to tell the Home Office about any changes, for example, if a visa application is wrongly refused.

I was reading the information on the link provided by ksand24 and I found below very useful for the situation. So I guess the most prudent thing to do at this point is to contact NHS ASAP and get on a repayment plan.

It is important to talk to the NHS to agree a payment plan and try to stick to the plan. You can ask to repay in small instalments e.g. £5 per month instalments if you can show that this is all you can afford to pay. The guidelines say that information about debt may only be passed to the Home Office where no reasonable arrangements have been made, or kept to, for repaying the debt.

If you pay the debt after the Home Office has been informed or you agree a payment plan, the NHS must inform the Home Office immediately. The NHS may be liable for any consequences of failing to tell the Home Office about any changes, for example, if a visa application is wrongly refused.

The bill would have to be paid down below £500 for there not to be an automatic refusal of the application. Simply agreeing to a payment plan wouldn't be enough.

eta, I'm not sure what effect a bill of less than £500 would have on the application as we always suggest people pay in full before applying.

I was in and out of the U.K. so never overstayed. Does anyone have personal experience with a denial based on NHS use?

I don't think we've seen many (if any) people get a refusal for NHS debt here on the forum, but I think that's mainly because we've managed to catch those people before they applied and made sure they requested bills and paid them first.

Thanks for the input everyone. I’m going to have my husband contact the immigration attorney we originally spoke to. I very much appreciate the advice on this forum. At this point I’d like legal representation if we receive a denial. This process is too sticky to keep messing around with. Thanks, everyone. It’s greatly appreciated.

Thanks for the input everyone. I’m going to have my husband contact the immigration attorney we originally spoke to. I very much appreciate the advice on this forum. At this point I’d like legal representation if we receive a denial. This process is too sticky to keep messing around with. Thanks, everyone. It’s greatly appreciated.

If you're going with a lawyer, there are only two we recommend here on the forum, as they specialise in US to UK fiance/spousal visas and we know they know what they are talking about.

They are:
- Medivisas (Beth or Victoria) - based in London
and
- Laura Devine - based in London and New York

I would be very careful with other lawyers because I've lost track of the number of people who have found UK-Yankee after being given very bad advice by lawyers, which either did or could have resulted in a visa refusal.

The bill would have to be paid down below £500 for it not to have a negative impact on the application. Simply agreeing to a payment plan wouldn't be enough.

eta, I'm not sure what effect a bill of less than £500 would have on the application as we always suggest people pay in full before applying.

I agree it's good advise to speak with an immigration lawyer. But I don't think it's necessary to pay down the debt to less than £500, based on the guidelines provided for data sharing between the NHS and Home Office.

Quoting below from the link:

The NHS cannot notify the Home Office of outstanding debts in any of the following circumstances:
-The NHS must not tell the Home Office about a debt owed by an EEA national, her/his family member or a non-EEA national who has derived residence rights in the UK because they are the carer of a British or EU citizen (known as Zambrano carers).
-The NHS must not tell the Home Office of outstanding debts if you are challenging the decision to charge you, for example, where there is a dispute about your immigration status or whether you are ordinarily resident.
-The NHS must not tell the Home Office if you have an agreed payment plan in place and you are sticking to it.
-The NHS must not inform the Home Office of outstanding debts where the debt has been cancelled.
-In Northern Ireland, the guidance states that the NHS must not inform the Home Office of a debt, if it has been written off. The England guidance is silent on this point.

And also refering to point# 14b (pages 5-6) of below:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/507694/Overseas_chargeable_patients_2016.pdf

I agree it's good advise to speak with an immigration lawyer. But I don't think it's necessary to pay down the debt to less than £500, based on the guidelines provided for data sharing between the NHS and Home Office.

Quoting below from the link:

The NHS cannot notify the Home Office of outstanding debts in any of the following circumstances:
-The NHS must not tell the Home Office about a debt owed by an EEA national, her/his family member or a non-EEA national who has derived residence rights in the UK because they are the carer of a British or EU citizen (known as Zambrano carers).
-The NHS must not tell the Home Office of outstanding debts if you are challenging the decision to charge you, for example, where there is a dispute about your immigration status or whether you are ordinarily resident.
-The NHS must not tell the Home Office if you have an agreed payment plan in place and you are sticking to it.
-The NHS must not inform the Home Office of outstanding debts where the debt has been cancelled.
-In Northern Ireland, the guidance states that the NHS must not inform the Home Office of a debt, if it has been written off. The England guidance is silent on this point.

And also refering to point# 14b (pages 5-6) of below:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/507694/Overseas_chargeable_patients_2016.pdf

Thank you! I have a couple of recommended immigration attorneys to contact plus a non profit organisation that I previously went to who will probably help us if we need it.

I'm sorry for your situation Calitobrum. I am not trying to argue with the visa experts on UKY because I do trust their advice 100%. They immediately knew my first application was bound for a refusal once I fully explained my situation. So I am now on my second application, after following all their advice.

My point in referring you to the guidelines for data sharing between NHS and the Home Office is to see if there was any possibility of mediating before you get a refusal. However, as also mentioned, the majority of past applications with your same situation were able to mediate BEFORE they submitted their applications.

If you're going with a lawyer, there are only two we recommend here on the forum, as they specialise in US to UK fiance/spousal visas and we know they know what they are talking about.

They are:
- Medivisas (Beth or Victoria) - based in London
and
- Laura Devine - based in London and New York

I would be very careful with other lawyers because I've lost track of the number of people who have found UK-Yankee after being given very bad advice by lawyers, which either did or could have resulted in a visa refusal.

Eurgh... think really, really hard before getting a lawyer. You’d have to get a really specific (read: expensive) lawyer to get anyone who’d know more about your situation than this forum. I’m not saying they don’t exist, just that they’d be very specialised and expensive and if you hire someone else instead, chances are they won’t know the system like this forum does.
If I were you I’d wait to see if you get a refusal. If you do, pay off your NHS bill and apply again. I’m no expert but it really seems there’s no way around this one.

I agree it's good advise to speak with an immigration lawyer. But I don't think it's necessary to pay down the debt to less than £500, based on the guidelines provided for data sharing between the NHS and Home Office.

Quoting below from the link:

The NHS cannot notify the Home Office of outstanding debts in any of the following circumstances:
-The NHS must not tell the Home Office about a debt owed by an EEA national, her/his family member or a non-EEA national who has derived residence rights in the UK because they are the carer of a British or EU citizen (known as Zambrano carers).
-The NHS must not tell the Home Office of outstanding debts if you are challenging the decision to charge you, for example, where there is a dispute about your immigration status or whether you are ordinarily resident.
-The NHS must not tell the Home Office if you have an agreed payment plan in place and you are sticking to it.
-The NHS must not inform the Home Office of outstanding debts where the debt has been cancelled.
-In Northern Ireland, the guidance states that the NHS must not inform the Home Office of a debt, if it has been written off. The England guidance is silent on this point.

And also refering to point# 14b (pages 5-6) of below:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/507694/Overseas_chargeable_patients_2016.pdf

I see the point that you are making.   And I was under the impression that a refusal because of NHS debt was automatic whereas it appears, see below, that it's discretionary.

Having said that, one thing you don't ever want to do with a visa application is rely on the discretion of the ECO. You should be presenting the strongest possible case so I still maintain that NHS debt should be paid in full before applying. Also, the rules have a nasty habit of tightening over time.

From the general grounds for refusal.

. This page contains guidance for entry clearance officers (ECOs) on what to consider when an applicant applying for entry clearance owes a debt to NHS bodies.
NHS bodies
The term ‘NHS body’ is defined in paragraph 6 of the Immigration Rules. In England an NHS body is an NHS Trust or NHS Foundation Trust. In Wales and Northern Ireland a number of bodies are NHS bodies, including the Local Health Board (LHB) in Wales and Health and Social Care (HSC) in Northern Ireland. In Scotland, Health Boards, the Common Services Agency and Healthcare Improvement Scotland are NHS bodies. For a full list of NHS bodies see the Immigration Rules: introduction.
Part 9 and Appendix V
You should normally refuse the entry clearance application under paragraph 320(22) for non-visit applications and paragraph V3.14 of Appendix V for visit applications if either of the following apply:
• the individual has an outstanding healthcare debt or cumulative debt of £1000 or more incurred on or after 1 November 2011
• the individual has debts of £500 or more incurred on or after 6 April 2016
An individual who has incurred charges of under £1000 before 6 April 2016 cannot
be refused on this basis after 6 April 2016 unless either of the following apply:
• they incur further charges of at least £500 after 6 April 2016
• they incur further charges after 6 April 2016 bringing the total outstanding
NHS debt since 1 November 2011 to over £1000
Appendix FM and Appendix Armed Forces
The Appendix FM routes are for those seeking to enter or remain in the UK on the
   
Related links
Refusing entry clearance: general guidance
Refusal wording
Safeguard and promote child welfare
External links
Considering human rights claims in visit applications
   
Page 65 of 71 General grounds for refusal Section 2 – version 29.0 Published for Home Office staff on 11 January 2018
This guidance is based on the Immigration Rules
          basis of their family life with a person who is a British Citizen, is settled in the UK, or is in the UK with limited leave as a refugee or person granted humanitarian protection.
The Appendix Armed Forces routes are for members of the armed forces, civilian employees and their families.
You may consider refusing the entry clearance application under Appendix FM and Appendix Armed Forces if either of the following apply:
• the individual has an outstanding healthcare debt or cumulative debt of £1000 or more incurred on or after 1 November 2011
• the individual has debts of £500 or more incurred on or after 24 November 2016
An individual who has incurred charges of under £1000 before 24 November 2016 cannot be refused on this basis after 24 November 2016 unless either of the following apply:
• they incur further charges of at least £500 after 24 November 2016
• they incur further charges after 24 November 2016 bringing the total
outstanding NHS debt since 1 November 2011 to over £1000
You must consider human rights factors in accordance with the Appendix FM guidance.
Consideration
You must check if the applicant has an outstanding total NHS debt that meets the above thresholds.
A person may have an NHS debt if they have received secondary healthcare, which is healthcare provided to the person by a hospital. For guidance on secondary care treatment in England see the Department of Health website.
           Page 66 of 71 General grounds for refusal Section 2 – version 29.0 Published for Home Office staff on 11 January 2018

This guidance is based on the Immigration Rules
          NHS bodies use their own internal processes to recover the monies owed, and will only notify the Home Office once the debt has been outstanding for 2 months and there is no agreement to pay by instalments.
Refusal on the basis of NHS debt is discretionary rather than mandatory. You must consider the following before refusing on the basis of NHS debt:
• you must be satisfied that there are no compelling or compassionate circumstances or human rights considerations that would make refusal inappropriate because discretion should be exercised in the person’s favour
• the unpaid debt relates to one or more NHS bodies and the total value of the debt is at least £1000 or more incurred on or after 1 November 2011 (for all case types), or either:
o (in the case of applications other than those made under Appendix FM /
Appendix Armed Forces) £500 or more incurred on or after 6 April 2016 o (in the case of applications made under Appendix FM / Appendix Armed
Forces) £500 or more incurred on or after 24 November 2016 in line with the relevant NHS regulations
You must only consider refusing an application on the basis of NHS debt if the NHS debt information has been supplied or confirmed by an NHS body.
          Official sensitive: start of section
The information on this page has been removed as it is restricted for internal Home Office use.

/quote]

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/673999/GGFR-Section-2-v29.0EXT.PDF

I think I’ll just have to wait and see if I’m refused. There is technically no outstanding NHS bill so nothing to pay. I’d have to have one generated which seems to me like a last ditch effort. If it was just a couple GP visits, no problem but it was an emergency delivery. Where does my care end and my daughters begin? Most attorneys I spoke to knew less than I did about immigration so they are a last resort. I guess my next question is what on earth do I do with my daughter. She’s British and I’m American. I had to buy a return ticket when leaving England because she is British. I’m sure it’s not a tough one to argue her overstaying in America...since I’m American, just another annoyance.