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Tuesday, September 21, 2021

Bupa is being a real pain over my dental claim

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I have a medical insurance policy with Bupa that doesn’t cover day-to-day dentistry, except for “surgical operations”. At a recent dental checkup, I was told I needed a wisdom tooth removed by an oral surgeon, so I filed a claim but Bupa has rejected it because I didn’t have any “active symptoms”. This isn’t a defined term anywhere in my policy, its wider glossary or its T&Cs.

I was told the policy will only provide cover where there are acute symptoms, “such as recurrent pain or infections that require treatment via antibiotics”.

DM, London

I, too, failed to find the terms that Bupa used to refuse your £500 claim. “Our policies don’t cover treatment where there are no symptoms to recover from, unless someone was in pain or had other symptoms,” it tells us.

“We’ll be happy to review the customer’s claim if their dentist is able to provide information about why we need it to be removed and how the impacted wisdom tooth is affecting his health.”

It seems that Bupa will only pay up if you are in pain. The Financial Ombudsman Service will arbitrate on whether the company has added this exclusion retrospectively. However, Bupa will have to pay the FOS more than it would have cost to cover your claim. I would also complain to the person at your company who manages the health cover.

Rail Europe – an update

Last month we featured the case of CW, who could not get a refund for the £185 he had paid Rail Europe for two sleeper train tickets from Paris to Venice, travelling in June 2020.

The train was run by an Italian company, thello, that has since stopped operating.

At the time, I couldn’t get Rail Europe, part of SNCF, to respond. After reading the piece, Rail Europe got in touch, and a refund was issued.

I had asked for other readers’ experiences of using RE. The majority came to its defence, saying they had received Covid-related refunds after services were cancelled. However, a smaller, but still significant, number were similarly still waiting for refunds.

We welcome letters but cannot answer individually. Email us at consumer.champions@theguardian.com or write to Consumer Champions, Money, the Guardian, 90 York Way, London N1 9GU. Please include a daytime phone number. Submission and publication of all letters is subject to our terms and conditions

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