Medical insurance - Refused claim: non-approved consultant/specialist

How does Resolver work?

Free forever

Resolver is free. Just raise a case and leave feedback after. Simple! We’ve helped millions of people find a resolution. Get started now and let’s get this sorted.

Know your rights

There’s no jargon in our rights guides. Instead, they’re full of the info you need to get things sorted. We’ll always be on hand with guidance and support to help you get the results you’re looking for.

Get your voice heard

You can be certain that you’re talking to the right person at the right time. We automatically connect you to contacts at thousands of household names, ombudsmen and regulators to find a resolution.

Based on resolver’s experience to date, you should always contact your insurer before going ahead with any medical treatment – otherwise you may have the unpleasant surprise – and expense – when you realise that you are not covered. Check your medical insurance policy small print carefully as there may be exclusions to the cover offered. Insurers will often cover the costs of a consultation with a specialist chosen from those on its approved list. Your GP may be able to recommend one from your insurer’s list. Be aware that if you see a specialist whose name is not on your insurer’s approved list then you run the risk of not being covered for your claim.

If you disagree with your insurer’s findings you should complain to the company directly. Ask for an address for customer services, and write giving clear details of your case - such as what treatment is sought, why this specialist must be used and why your insurer should permit you to make use of him. If you are not happy with the outcome then as a last resort you can contact the Ombudsman, which will act as a mediator in your case. resolver recommends that you submit your concern in writing and resolver can assist you in submitting, recording and reminding you when and who to escalate to.

Resolver can help you resolve this issue quickly, free of charge and without the hassle. We can also help you with the next step of writing your complaint. Click on the link below to create your email.
You should know

If you’re making a complaint about making an insurance claim rather than a mis-sold policy, check your documents to see who the “underwriter” is. You’ll need to make a complaint to that organisation.

If you cannot resolve your issue you cannot raise your case to the Ombudsman until 8 weeks after you have first raised your complaint with your provider, or you have received a ‘letter of deadlock’ from the company stating that they cannot resolve the issue as you have asked. Your complaint must also not be older than 6 months. For an accurate decision by the Ombudsman you should provide a detailed file of your communications and supporting documentation. In addition make sure you explain what you want as an outcome as this will help assess your case.

Find the best rights for you

We have 5,116 pages of rights advice for you covering 10,936 companies and organisations across 16 public & private sectors. Feel free to browse companies for this specific issue - they're all listed below - but the quickest way to find the best rights for you is by using our unique Rights Finder to access our extensive database of advice.

Start by telling us the name of the company or organisation you have an issue with.