Any private medical insurer who made it clear that they would cover weight-loss treatment to cut the risk of complications ahead of surgery would “clean up,” according to Rhys Schofield, protection adviser for Peak Mortgages and Protection.
Schofield spoke to Health & Protection following data last week showing private medical insurance (PMI) and protection complaints to the Financial Ombudsman Service (FOS) had increased year-on-year across virtually all major product categories.
He maintained the increase in complaints came as no surprise, particularly due to the PMI sector “creaking” under an increased workload.
Not helping themselves
But Schofield also added that he does not think insurers are helping themselves by failing to adjust to medical innovations, citing the example of a client he dealt with last week.
“I’ve had a client hit the roof because her PMI provider has agreed to cover her hip replacement but her consultant has recommended she take GLP-1’s to lose some weight before the procedure in September, to speed her recovery and reduce the risk of complications,” he said.
Common sense
Schofield maintained this would also be beneficial to the customer’s health in the long term too.
“This is common sense, right? A couple of hundred quid for what the insurer’s appointed clinician is saying is a good idea, and easing recovery/reducing the risk of complication or further claims is as much of a bonus for the insurer as the client seeing as they’re the ones on the hook to pay for it.
“But we got the flat ‘we don’t cover any weight-loss medication at all, jog on’ which to me doesn’t seem to do the insurer any favours from a PR perspective.
“I understand not wanting to open the floodgates but on the other side with clients’ health we should take situations on their merits.”
Cleaning up
And Schofield added that he believes there is a market opportunity here for enterprising PMI providers.
“I think if an insurer offered an enhanced option where they made it clear that they would cover stuff like this they’d clean up,” he said.