HSA enrages Jewish community with unpaid health claims

Hundreds of Jewish families claim they have been left out of pocket because a leading health insurer has failed to pay out for their treatment.

They are backed by angry dentists, opticians and chiropodists who say insurer HSA has failed even to respond to applications they made on behalf of the patients.

Many of the patients are from large strictly Orthodox families in Stamford Hill, north London. They are furious at the lack of response.

One community leader believes Jewish families are being “targeted” because of the large number of children on their policies, a claim that HSA denies.

Ita Symons, head of the Agudas Housing Association in Stamford Hill, said: “It’s the first time I’ve heard of what appears institutional discriminatory behaviour in this country.

“I’m shocked that such a company appears to be targeting the Jewish community, who signed up for policies in good faith and who rely on being reimbursed for treatments.”

HSA said: “Our database does not hold details of ethnicity or religion, and any claim reviews would be based on an objective assessment of the facts.”

One dentist says he is considering legal action after 50 of his patients were told they would not be paid for claims made via his surgery. The insurer said the dentist had not responded to letters requesting invoices, something he emphatically denies.

Dr Baruch Davidoff, of Stamford Hill, is still trying to get a response from HSA, despite having sent several letters and emails. He said: “I sent out letters to the chief executive of HSA in March asking that they resend the ‘correspondence’ by recorded delivery but there’s been no response.

“I recently sent emails asking for an explanation as to why no-one has communicated with me at any stage, but I just get bounced around by customer services. My questions aren’t going anywhere.”

Homeopath Judith Posen has advised patients chasing for claims to “call them directly” after so many of her clients complained they were not being paid. She said: “HSA claim that they can’t pay out on treatments because I’ve not responded to their letters — but they’ve never written.”

Michael De Jong, practice manager of Silverman Opticians, said: “Hundreds of my patients are owed money from HSA,” while chiropodist Steven Weiner said he had “never been contacted by HSA”, despite more than a dozen of his patients being told he had been sent correspondence.

Dr Michael Horowitz, a Stamford Hill GP whose wife and eight children were insured with HSA, says he is owed £800 for treatments.

He says a company representative visited his home in March and examined receipts and bank statements. He was even asked to show his children’s birth certificates.

But more than a month later he was told by phone that his insurance £45-a-month premiums had been cancelled. They have still not received payment for treatments.

He was one of several spoken to by the JC whose policies had been terminated after questioning why they had not been paid.

Miriam Veiss-Fish received a letter in February telling her that her policy was under review after she queried non-payment of her £400 claim.

She phoned customer services several times to be told it was “under review”.

Last week she received a letter telling her HSA was cancelling her premium payments until further notice.

HSA, which is part of the Simplyhealth group of medical practitioners, is attractive to Orthodox families because their Health Cash Plans provide insurance for “unlimited children” at relatively low premiums.

Describing itself as having “helped people to access healthcare since 1922”, HSA promises to pay out on claims “within two days of receipt”.

HSA said that it was “standard practice within the insurance industry to monitor claims and use external claims investigators where appropriate. This protects our business and our customers and also helps us keep premiums low.

“If we identify cases where we are unable to obtain sufficient evidence to satisfy ourselves that the medical treatment the customer is claiming for actually took place, then we may refuse to pay the claim, and in some cases terminate the policy. In doing so, we are acting in accordance with our terms and conditions.

“We encourage people with families to join our plan. If a customer is on a Health Cash Plan that allows them to claim for unlimited children, we would honour claims up to the annual limits, regardless of the number of children.

“However, for each claim, we would need sufficient evidence that the treatment being claimed for actually took place, evidence that the children are living at the same address as the parents, and a valid birth certificate for each child receiving treatment.”

The Board of Deputies has written to HSA, and said it was “extremely concerned to hear of the complaints that members of our community have made against HSA”. It has asked the company why “such a large number of claimants have had this problem”.

Claims and counter-claims

Dr Michael Horowitz’s wife and eight children’s policy has been under review for four months; they are owed £800. A representative from HSA came to their house in March to examine receipts and bank statements.

Two weeks ago they were told by phone that they were no longer being charged premiums. They have still not received payment for treatments.

Esther Isaacs has four children on her policy. Three months ago she sent off a receipt from a chiropody treatment. When she was not paid, she asked what was going on. She received a letter at the beginning of April, saying she was under investigation.On April 20 she was told that attempts to make contact with the chiropodist had failed and therefore her policy was cancelled.

Helen Webber, her husband and five children have a policy. The policy was cancelled five weeks ago, a month before she was due to give birth, by HSA although she was owed £200 for treatments involving dentistry, optometry and acupuncture.

HSA claimed it had not received any information from practitioners concerning her claims.

Practitioners

Michael De Jong, is practice manager, Silverman Opticians, Stamford Hill. Over 100 policy-holders are owed money for claims made at his practice.

Steven Weiner is a chiropodist in Stamford Hill. Since January HSA has been interviewing his patients asking them for receipts of treatments. In March patients started complaining that Mr Weiner had not responded to letters from HSA, but he says he never received any.

Three weeks ago a patient said he had been told that a receipt could not be paid because HSA could not get hold of Mr Weiner.

At least 10 patients have been affected and are owed several hundred pounds from treatments he has provided.

    Last updated: 3:21pm, May 21 2009