One third of Which? members confused by PMI coverHow to make a complaint about your PMI provider

21 August 2013

Doctor and patient

Almost one third of Which? members who have private medical insurance are confused by the level of cover offered by their package, a new Which? survey has found.

PMI coverage confusion

The survey of 1000 Which? members found that 75% of respondents made a claim on their private medical insurance (PMI) since taking out their policy. 

But 10% of those who made a claim were told they weren't covered for treatment when they believed otherwise.

Not all PMI policies are as comprehensive as others, and they are often graded by price. One common problem with private medical insurance cover levels can be a lack of availability of certain medicines or treatments.

But, if you suspect the level of insurance cover that you're being offered breaches your contract, you may be able to challenge your provider. 

Your right to complain

Of the quarter of Which? members who experienced a problem with their PMI, around one third made a complaint. Only 50% of these complaints were resolved.

If you have a problem with your private medical insurance cover level, the first step is to speak to your provider.

If your problem can't be resolved, the Financial Ombudsman Service will investigate cases where service or administrative errors have occurred.

Worries about service

Under the Supply of Goods and Services Act, your care must be provided with reasonable care and skill. 

If you feel this has not been the case, you can make a complaint and you may be entitled to a corrective treatment or a refund. But, make sure you consider carefully before accepting any offer of compensation. 

If you’ve suffered pain, inconvenience or extra cost, you may wish to seek legal advice in order to file a personal injury claim.

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