BUPA - What DOES it cover?

My husband suggested I look into BUPA private insurance to make sure I can get appointments when I need one, and not at the NHS's leisure.  I agreed this seemed like a good idea, but then sort of dismissed it for about 5 years.  But my neighbor revealed to me last week that they have BUPA cover, and the husband had cataract surgery covered by it earlier in the year, and she's about to have a hip replacement for it.  So I finally decided to look into it and what it costs.  It looks like unlimited cover is going to be around £56/month for me (based solely on my age and non-smoker status, as that was all the information I'd provided when I got that quote).  But there's a long list of things it doesn't cover, and I'm not sure I see the point.  It doesn't cover chronic conditions, for instance, or problems that result from a chronic condition (?).

If I were to get specific about my concerns, I might say that I have mitral valve prolapse with moderate regurgitation that is progressive and will need repair or replacement in the future... and I might say that in the US, I had annual echocardiograms to monitor the condition... and I might say that since my last trip home in the winter of 2012/13, I haven't had it looked at.  That's 5 years, and the last time they looked, my cardiologist was saying "when", not "if", when talking about surgery.

Partly, this five year gap is my fault... I didn't bother registering with a GP at the old house because we were so certain we were moving any day (it took us 2 years to find a house to offer on, and another 6 months to complete the purchase!).  I finally registered with my GP at our new address last year and he knows my health history (they booked a double new-patient slot, and we had a nice long chat, and I left my old outpatient records with him, whicn I need to get back).  He said he was putting in a referral for cardiology.  That was 15 months ago.  I've not heard anything yet.  By now, I would've had two more echoes in the US.  I'm starting to think I won't ever get in.

So, would BUPA cover this, or am I stuck waiting for NHS?  Should I phone my GP and see if they've actually lost my referral and I've been waiting in vain?

I doubt they would cover it because Insurance is for things that might happen not things that have already happened. If I had a leak in my roof I would not be able to get house insurance in order to have it fixed because the leak in the roof is a pre existing condition. It will be the same with a leaking heart valve that needs repairing or replacing.

When I and my wife signed up for health insurance in England with Aviva we had to disclose any and all pre-existing conditions and I would think that BUPA will be the same. There was an option to not disclose but if we needed treatment for a condition for which the NHS had a record of within the last 5 years the treatment at a private facility would be denied.

To me it sounds like the referral never happened. I'd have called after a couple of months, just to make sure that it was at least in progress!

Call tomorrow. 

To me it sounds like the referral never happened. I'd have called after a couple of months, just to make sure that it was at least in progress!

Call tomorrow. 

Absolutely. I think you have to keep on their case.

To me it sounds like the referral never happened. I'd have called after a couple of months, just to make sure that it was at least in progress!

Call tomorrow. 

Absolutely. I think you have to keep on their case.

I wasn't sure... I'd heard about long waits for referrals, so when mine didn't come through, I thought that was just the nature of the beast.  And I'd been a bit complacent about it since the move, anyway, so I was going to wait it out.  But I'll phone tomorrow and have them investigate.  My GP was a bit overwhelmed by all the things.  Maybe he just missed one out. 

The Daughter's insurance won't cover pre-existing conditions until she's been without any sort of treatment or medical visits for them for a minimum of two years. After that point, I think she has some cover, but it's lower than if she had no pre-existing condition.  Should say somewhere in the Bupa prospectus how they handle it?

I wasn't sure... I'd heard about long waits for referrals, so when mine didn't come through, I thought that was just the nature of the beast.  And I'd been a bit complacent about it since the move, anyway, so I was going to wait it out.  But I'll phone tomorrow and have them investigate.  My GP was a bit overwhelmed by all the things.  Maybe he just missed one out. 

You can also jump the queue by paying for a visit to a specialist and it is actually cheaper than you might think. Once you have paid to see a special and he confirms that you need a procedure then you are in the system and on the list.

I wasn't sure... I'd heard about long waits for referrals, so when mine didn't come through, I thought that was just the nature of the beast.  And I'd been a bit complacent about it since the move, anyway, so I was going to wait it out.  But I'll phone tomorrow and have them investigate.  My GP was a bit overwhelmed by all the things.  Maybe he just missed one out. 

And explain that you are now *very* overdue for an echo. They might be able to put you through as urgent. You don't want to mess around when it comes to hearts!

And explain that you are now *very* overdue for an echo. They might be able to put you through as urgent. You don't want to mess around when it comes to hearts!

I'll do that.  I am running very low on my maintenance inhaler (the steroid one), and I need to ask if he's still got my old records I brought with me from the US, anyway.  I'll have a nice chat with them.  They're gonna love me. 

And explain that you are now *very* overdue for an echo. They might be able to put you through as urgent. You don't want to mess around when it comes to hearts!

Yup.  This.

To answer your question - I don't think Bupa will "do" anything for you.  The NHS will cover what you need.  And there are different paths that can be taken (urgent versus non-urgent).  I would nudge you to request an urgent referral now (would be two weeks normally) and then ask for regular intervals.  Once you are "on the path" and have a cardiologist, you shouldn't find wait times and such to be an issue anymore.  You'll just have regular appointments.  My husband sees his specialist every six months like clock work. 

As Durhamlad said, a direct private appointment with the cardiologist would not be a scary cost.  It would be MUCH less than a year of Bupa for example (maybe a couple of hundred £££).

Yup.  This.

To answer your question - I don't think Bupa will "do" anything for you.  The NHS will cover what you need.  And there are different paths that can be taken (urgent versus non-urgent).  I would nudge you to request an urgent referral now (would be two weeks normally) and then ask for regular intervals.  Once you are "on the path" and have a cardiologist, you shouldn't find wait times and such to be an issue anymore.  You'll just have regular appointments.  My husband sees his specialist every six months like clock work. 

As Durhamlad said, a direct private appointment with the cardiologist would not be a scary cost.  It would be MUCH less than a year of Bupa for example (maybe a couple of hundred £££).

Do you think that couple hundred would include the echocardiogram?  I've always had full cover in the US, so I have no idea what anything costs!  I know that paying for healthcare here is cheaper than in the US, but I don't have a reference point for what "cheaper" means.

I'll try going for the urgent referral, and if that takes too long, I'll consider springing for a private appointment.

£175 in Bridgend

https://www.privatehealth.co.uk/conditions-and-treatments/echocardiogram/costs/

Do you think that couple hundred would include the echocardiogram?  I've always had full cover in the US, so I have no idea what anything costs!  I know that paying for healthcare here is cheaper than in the US, but I don't have a reference point for what "cheaper" means.

I'll try going for the urgent referral, and if that takes too long, I'll consider springing for a private appointment.

This is the first that came up when I googled it, £295 for echo and specialist report.

http://www.heartscan.co.uk/private-echocardiography/how-much-does-a-private-echo-cost

£175 in Bridgend

https://www.privatehealth.co.uk/conditions-and-treatments/echocardiogram/costs/

Oh there you go! Cheaper in Wales! 

£175 in Bridgend

https://www.privatehealth.co.uk/conditions-and-treatments/echocardiogram/costs/

Oh there you go! Cheaper in Wales! 

Free prescriptions here, too.  Wales is amazing!

Aaaaand I just got off the phone.  They don't have a record of my visit with the GP!  They see where I saw the nurse for the asthma clinic, but then I had a long GP appointment immediately after, and I left my records that I brought over with me from America with him... Ugh.  They took my number and are looking into this for me.  So, they didn't just lose my cardiology referral, apparently.  Good that I phoned!