Health insurance firm owes families hundreds

By James Martin, December 17, 2009

Policy-holders owed hundreds of pounds in claims have not received payouts on their medical cash plans since January.

Simplyhealth, which has taken over the HSA medical insurance group, promised “to settle on valid claims as quickly as possible” in August after admitting that customers had been given “limited information” about the status of their claims since the HSA began its claims investigations in January.

However, despite demanding full clinical records of treatments from dozens of Orthodox families in the Stamford Hill area, who were attracted by the offer of medical insurance on unlimited children, there are several policy-holders whose claims are still under review.

Susan Horowitz, a mother of nine living in Stamford Hill, has not heard from Simplyhealth since the end of August.

She claims she was “messed around” by the insurer, despite complying with its requests for additional information.

“In early August I was asked to provide full clinical records for 12 dental and optometry treatments worth £600, which I have claimed for but not been paid.

“I did this and hoped it might be the end of the matter. Then I returned from holiday and found I’d been sent another letter saying ‘it wasn’t enough to substantiate the claims’ and they needed more information.

“So I sent it to them, but I’ve heard nothing since.”

Mrs Horowitz, who recently had a ninth child, has had her policy frozen since May. She added: “If they have evidence of invalid claims where is it? They expect me to do things in double-quick time but they are not even in contact with me.

“I suspect they are trying to get people with bigger families to give up on being paid back.”

Meanwhile she is unable to get insurance elsewhere: “I’ve spoken to another insurer who said that they won’t offer cash plans to people from N15.”

Miriam Veiss-Fish is still owed £400 for treatments claimed since January, despite sending details of the same claims several times over.

The mother of ten said: “We’ve not been able to make claims for nearly a year despite having now sent proofs of the same treatments several times.

“I sent proofs of claims in August, when I was asked to provide full clinical records of treatments. I then got a letter in September asking for a ‘clearer invoice’, including copies of X-rays, to be sent within a week.

“My husband sent them the requested information a few weeks later with a note saying we couldn’t possibly get it done in that time-frame.”

Asked whether they had now concluded their investigation on the majority of claims, Simplyhealth said: “Our review is progressing and we are working with our customers to help bring this to a conclusion. We have nothing further to add.”

Last updated: 4:47pm, December 17 2009