Visa Denial Question

There is technically no outstanding NHS bill so nothing to pay.

Try to stop thinking about it in this way. The fact that you haven't been presented with a bill doesn't mean there's nothing to pay. It just means that you haven't been given a bill for what you owe. It's not a technicality, it's just that the NHS is still adjusting to the new requirements for visitors and they're not accustomed to charging people. This does NOT mean that you don't owe anything -- you still received treatment that you weren't entitled to have for free.

As far as your daughter, she is an American citizen by descent, so you'll need to get her an American passport. I'm guessing she has a British one that you used when you took her to the US?

There is technically no outstanding NHS bill so nothing to pay.

There is a difference between having no bill and having no debt. Just because you were not given a bill, doesn't mean there is nothing to pay and that you don't owe any money. The immigration rules use the word 'debt', not bill.

Basically, UK tax payers paid for the birth of your child, when they should not have had to. You should have been the one to pay for it, because you were not entitled to utilise UK tax payers money.

I’d have to have one generated which seems to me like a last ditch effort.

Last ditch effort? Getting a bill should be top priority in a situation like this.

Your situation is no different to anyone else's, and paying for your treatment is a requirement. Many visitors to the UK use the NHS every day and they all have to pay for their treatment (even if they don't get a bill at first)... why should you be a special case?

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?

For you, any immediate emergency treatment in A&E is free. Any treatment outside of A&E is not free.

For example, if you were in a car accident and were taken to A&E, your ambulance and immediate care in A&E will be free, but as soon as you are transferred to a ward, or are discharged and seen as an outpatient, you have to pay for everything.

As your daughter is a UK citizen, all her treatment should be free, but any treatment you receive after the birth is not.

Most attorneys I spoke to knew less than I did about immigration so they are a last resort.

Hence the reason we don't recommend using a lawyer .

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.

Actually, your daughter is also American. Providing you qualify to pass your citizenship to her (based on your US residency), she will have been a dual citizen since birth and is entitled to both UK and US passports.

Ideally, she should have obtained a US passport before you took her back to the US, as US citizens cannot enter the US on a foreign passport. It would have involved registering her birth abroad with the US Embassy and applying for her first US passport.

I would register her birth with the US government and get her a US passport while you are waiting for your visa to be processed.

We've had three refusals for NHS usebon the forum since I've been a member.

One was cancer treatment.  He was told his treatment was free.  When he applied for the spouse visa, he received a refusal and a bill for over £99,000 in the same week.  His story is long and involved to say the least.

Another was a birth.  She received a refusal.  Paid a couple of thousand pounds, reapplied and was successful.

The third was also a birth.  Her trust refused to bill her and instead the head of the trust wrote a letter to UKVI that her care was free of charge.  She reapplied and obtained her visa.

Good luck with whatever you decide. 

There is a difference between having no bill and having no debt. Just because you were not given a bill, doesn't mean there is nothing to pay and that you don't owe any money. The immigration rules use the word 'debt', not bill.

Basically, UK tax payers paid for the birth of your child, when they should not have had to. You should have been the one to pay for it, because you were not entitled to utilise UK tax payers money.

Last ditch effort? Getting a bill should be top priority in a situation like this.

Your situation is no different to anyone else's, and paying for your treatment is a requirement. Many visitors to the UK use the NHS every day and they all have to pay for their treatment (even if they don't get a bill at first)... why should you be a special case?

For you, any immediate emergency treatment in A&E is free. Any treatment outside of A&E is not free.

For example, if you were in a car accident and were taken to A&E, your ambulance and immediate care in A&E will be free, but as soon as you are transferred to a ward, or are discharged and seen as an outpatient, you have to pay for everything.

As your daughter is a UK citizen, all her treatment should be free, but any treatment you receive after the birth is not.

Hence the reason we don't recommend using a lawyer .

Actually, your daughter is also American. Providing you qualify to pass your citizenship to her (based on your US residency), she will have been a dual citizen since birth and is entitled to both UK and US passports.

Ideally, she should have obtained a US passport before you took her back to the US, as US citizens cannot enter the US on a foreign passport. It would have involved registering her birth abroad with the US Embassy and applying for her first US passport.

I would register her birth with the US government and get her a US passport while you are waiting for your visa to be processed.

In no way do I think I’m a special case and it was not my intent to have U.K. tax payers pay for the birth of my child. Please don’t imply I’m trying to take advantage. I’m not trying to avoid paying a debt or money owed to the NHS for my care. I was naively under the impression that because I was never billed there was no debt. I also thought that because we are paying a health surcharge and my taxes will go to the NHS that this wouldn’t be an issue. Apparently I was wrong. This is all a learning experience. I haven’t applied for my daughters American passport so she’s not a dual citizen yet. We don’t have much money at the moment so that will have to wait.

We've had three refusals for NHS usebon the forum since I've been a member.

One was cancer treatment.  He was told his treatment was free.  When he applied for the spouse visa, he received a refusal and a bill for over £99,000 in the same week.  His story is long and involved to say the least.

Another was a birth.  She received a refusal.  Paid a couple of thousand pounds, reapplied and was successful.

The third was also a birth.  Her trust refused to bill her and instead the head of the trust wrote a letter to UKVI that her care was free of charge.  She reapplied and obtained her visa.

Good luck with whatever you decide.

Thanks. This will probably be our situation. Anything we need to pay we will.

I haven’t applied for my daughters American passport so she’s not a dual citizen yet. We don’t have much money at the moment so that will have to wait.

She is a dual citizen - not having a passport doesn’t mean she isn’t a citizen. If it did, then that would mean that the 64% of Americans who do not hold a passport are illegal immigrants!

However, to record her US citizenship officially, you will need to register her birth with the government.

After that you can apply for her US passport.

See:
https://travel.state.gov/content/travel/en/international-travel/while-abroad/birth-abroad.html

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Thanks. This will probably be our situation. Anything we need to pay we will.

It's a shame the policies and the front end staff aren't in sync.  It's not fair on families to leave believing they don't owe and then being stuck with a bill for thousands.

But this is ALL easily fixed.  Will just take a bit of time and unfortunately money.  Just hate to see you lose the application fees.   

Try to stop thinking about it in this way. The fact that you haven't been presented with a bill doesn't mean there's nothing to pay. It just means that you haven't been given a bill for what you owe. It's not a technicality, it's just that the NHS is still adjusting to the new requirements for visitors and they're not accustomed to charging people. This does NOT mean that you don't owe anything -- you still received treatment that you weren't entitled to have for free.

As far as your daughter, she is an American citizen by descent, so you'll need to get her an American passport. I'm guessing she has a British one that you used when you took her to the US?

Thanks. It’s hard to wrap my head around. When I started receiving treatment I was told that I might need to pay and if I did I’d be billed. If no bills than no. That’s what I find misleading and hard to understand but apparently doctors don’t understand the process either. If I had known I would have started a payment plan before applying for a spousal visa. It’s very unfortunate the lack of advice on the U.K.gov site.

It's a shame the policies and the front end staff aren't in sync.  It's not fair on families to leave believing they don't owe and then being stuck with a bill for thousands.

But this is ALL easily fixed.  Will just take a bit of time and unfortunately money.  Just hate to see you lose the application fees.   

I feel stuck. My husband wants to wait for the decision but I’d rather get this dealt with. I’m not sure where to start. My GP? The hospital? How do they start putting together a bill of something that doesn’t show as being owed? That’s where I’m totally confused.

larrabee, ahh yes. Discretion is truly a hard thing to navigate. I agree.

As I see it, personally I would still try to contact NHS ASAP if there is a slim chance I can stop NHS from reporting (confirming) the debt to Home Office.

Unfortunately for Calitobrum the application has already been submitted so timing is of essence.

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Thanks. It’s hard to wrap my head around. When I started receiving treatment I was told that I might need to pay and if I did I’d be billed. If no bills than no. That’s what I find misleading and hard to understand but apparently doctors don’t understand the process either. If I had known I would have started a payment plan before applying for a spousal visa. It’s very unfortunate the lack of advice on the U.K.gov site.

It may be that they opt not to charge you. In that case, you just need a letter from them verifying that. I’d contact the hospital, myself, since the GP wasn’t the one responsible for the actual birth.

I feel stuck. My husband wants to wait for the decision but I’d rather get this dealt with.

Personally I would get on that NHS bill, and either pay the bill in full, or set up the payment plan ASAP, just because there is that slim chance of salvaging the application. Of course it’s not a guarantee, because as larrabee mentioned it’s still up to the ECO’s discretion.

“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.”





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Thanks! So in both of your opinions, contacting the NHS/Hospital won’t make the situation worse? I know I listed my GP on my visa application and how long I’ve received care. I’m so frustrated with myself that I didn’t know any of this. I honestly thought that because medical staff turned over my case for review and since we weren’t billed they had decided to pay the birth through NHS funds.

contacting the NHS/Hospital won’t make the situation worse?

I think this is demonstrating good faith to both NHS and Home Office. But that’s my opinion.

Whether you get an approval or a refusal, you will still have to settle the debt either way. I just prefer settling issues as quickly as possible.


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Thanks! So in both of your opinions, contacting the NHS/Hospital won’t make the situation worse? I know I listed my GP on my visa application and how long I’ve received care.

It can only help things. If you listed a GP on the application and stated you received treatment, and at the time of the treatment you did not have a visa for which you had already paid the IHS, then they will wonder where your evidence of payment is.

So, by contacting the hospital, you are getting a head start on sorting it out... so if UKVI do contact you to ask for evidence of payment, or if the visa is refused, you will already have got the ball rolling and will be working on getting it sorted out, which will save time later on.

I’m so frustrated with myself that I didn’t know any of this. I honestly thought that because medical staff turned over my case for review and since we weren’t billed they had decided to pay the birth through NHS funds.

The thing is that the NHS is not set up to bill people - the idea was that it was free healthcare ‘to all’... so they never had to worry about generating bills. And to be honest, until recently, a lot of NHS staff weren’t aware that certain people did need to pay, and so if people questioned it, they would just dismiss the idea of paying, because in their experience ‘no one has to pay’. The hospital staff aren’t thinking about where the funds are coming from for the treatment, they are simply focused on treating you, regardless of who is paying.

That’s unfortunately why the responsibility ends up landing on the visitor themselves to be firm, stand their ground and say: ‘hang on, I know the rules for visitors and I know I’m not entitled to get this for free, therefore I have to insist that you bill me for this treatment’.

One other thing is that the IHS surcharge pays for FUTURE treatment only, not past treatment, so even though you have paid it, it will only cover you for any healthcare you receive during the 2.5 years on the spousal visa. It doesn’t make up for not paying for any treatment you received in the past.



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