By
James Martin
3 min read
By
James Martin
A leading member of Stamford Hill’s strictly Orthodox community, Rabbi Avraham Pinter, has accused the medical insurer HSA of “discrimination”.
Last week the JC revealed that hundreds of Jewish families have been left out of pocket due to the insurer’s refusal to reimburse them for treatments.
They are supported by furious dentists, homeopaths, chiropodists, herbal doctors and opticians, who say HSA has failed even to respond to applications they made on behalf of patients.
HSA refused to respond directly to Rabbi Pinter’s challenge. Instead it insisted: “Our database does not hold details of ethnicity or religion, and any claim reviews would be based on an objective assessment of the facts.
“We have a regulatory duty to monitor claims continuously...If there happens to be a number of claims from a similar geographical location that we can not substantiate, then for convenience we may choose to review customers at the same time.”
HSA, which is part of the Simplyhealth group of medical insurers, has been conducting “reviews” of selected policies since January. Since then, the holders of those policies have been unable to receive payouts on claims, despite paying premiums.
In the past few weeks, a large number of patients have had policies cancelled without explanation.
Rabbi Pinter, head of Yesodei Hatorah School, said he had cancelled his policy with HSA “as a point of principle”, adding: “I’ve not made a claim with them for a long time but I cancelled because they are discriminating against members of the Orthodox community in Stamford Hill.”
He has also made a complaint to the Financial Services Authority.
Robin Gordon-Walker of the FSA said the regulator is “duty-bound to investigate any suggestions of a firm mishandling its terms and conditions”, adding: “Good claims-handling includes dealing with customers fairly and quickly is very important.
“When you are not upholding claims you must give full reasons.”
The FSA forced HSA to change its terms and conditions four years ago after describing the insurer’s grounds for terminating policies as “detrimental to the rights of consumers”.
Some claimants are owed more than £1,000 by the insurer, which attracts large families by offering insurance for “unlimited children” on one policy.
Isaac Kraus’s policy was terminated despite being owed £1,200 for dental, chiropody and homeopathy treatments, claimed since October.
“They sent me a letter in January saying they were reviewing my policy for four months,” said Mr Kraus, who is owed payments for 15 claims, covering eight family members on his policy.
“I thought this was a standard practice and so I continued to make claims, since I was paying premiums,” he added.
“But a few weeks ago I received a letter saying my policy had been terminated, without a reason.
“I complained. Last Friday I had a letter saying HSA was no longer dealing with complaints and I should go to the Financial Services Ombudsman.”
One man who did successfully complain was Leivi Vogel, who was finally paid £150 for treatments he had received.
He challenged the insurer over its right to conduct a review indefinitely, after making an internal complaint in February.
“At first, they defended their right to conduct policy reviews under their terms and conditions, but I said this couldn’t go on indefinitely.
“They then claimed they could hold back payments, and that they could ultimately terminate policies if practitioners were not providing them with the requested information.
“But when I asked for copies of letters they’d sent to my homeopath and optician [asking for details of Mr Vogel’s treatment], they paid out.”
Herbal doctor David Rosenberg, who said that more than 50 of his patients were still waiting for payments, said: “Claims that were being accepted two years ago are not being paid out now. Previously, HSA would regularly check my invoices for claims made by customers, but they haven’t been in touch since the review process began.
“A decision appears to have been made, out of the blue, not to pay out on treatments claimed under me.”
Mark Frazer from the Board of Deputies said: “As the number of complaints increases, a clearer picture is developing of the amount of people that have been affected by this and the sums of money involved. We are now awaiting a response to these allegations from HSA, and we will reassess the situation.”