How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask JGM Your Own Question
JGM, Solicitor
Category: Scots Law
Satisfied Customers: 12081
Experience:  30 years as a practising solicitor.
Type Your Scots Law Question Here...
JGM is online now

I had healthcare through my employer and my wife was covered.

This answer was rated:

I had healthcare through my employer and my wife was covered. In January we used the cover for my wife and it was explained and not disputed by the healthcare provider that my wife would have a consultation, treatment and follow up all on the one claim. The follow was scheduled for August as directed by the consultant. I was made redundant from the company 28th May. My wife attended the follow up as we were told it was all part of the initial claim. Now both the healthcare provider and Trustees of the scheme are refusing to pay.
Where do we stand?
Thank you for your question.

Who told you it was part of the same claim and that the follow up would be covered. And what does the scheme say about it?
Customer: replied 2 years ago.
When we phoned to see if my wife was covered for the treatment, the healthcare provider stated the process would be a consultation, treatment and a follow up all part of one claim and there would be no need to phone for approval at any stage.
The healthcare provider agree that is the case however because of the time scale for the follow up they say I am no longer covered by the plan regardless that they admit it is not a new claim. At no point did they inform me that this claim was still open and because I was made redundant would no longer be covered. It was only after my wife attended the appointment for the follow up that they are now saying we are not covered even though it is not a new claim.
The trustees view this as a new claim and refuse to cover.
They are both wrong. The healthcare provider made a representation that the three components would be part of one claim and they really can't rename on that now.

The trustees cannot view this as a new claim if they passed the original claim as being the three components of consultation, treatment and follow up.

I would do a letter to both of them telling them to sort it out between themselves and that if they have misrepresented the position to you that is not your problem.

I hope that helps.
JGM and other Scots Law Specialists are ready to help you