A client of mine got in touch recently. Let’s call him Richard. A fairly typical client — London-based entrepreneur, runs several successful businesses, and has a solid international policy that doesn’t cost him a fortune.
He went for a consultation with a reputable private GP. Complained about chronic tiredness, stress through the roof and on top of that - insomnia. The doctor listened carefully and as soon as the conversation turns to insurance, she has dropped the classic line that triggers my eye twitch every time I hear it:
“Oh, you want to put this through your policy? I’ve seen it before — your insurer probably won’t cover it.”
Right.
Let me tell you the most common diagnosis I give to doctors - It’s an acute lack of knowledge about policy wordings with chronic complications of wanting to treat not just the health, but also the paperwork.
Richard left the appointment thinking - “What’s the point of this policy, if they’re just going to reject the claim?”
Here’s the part that frustrates me the most - the doctor wasn’t technically wrong. She had indeed heard of similar cases being declined. She just didn’t know why and that’s where the biggest issues lays.
Let’s review this situation one more time:
Richard told the doctor that (among a list of other symptoms) he couldn’t sleep well recently. The doctor has referred him for a course of CBT, stating insomnia as the primary issue in a referral. And guess what? His policy clearly excludes sleep disorders (which, by the way, is a fairly standard exclusion among all insurers).
BUT…
If that same insomnia was correctly documented as one of the symptoms of anxiety (or in other words a mental health condition) which IS covered — then suddenly we’re talking about a very different outcome here.
So no, the insurer wasn’t the issue in this case. The problem was how the referral was written and the (lack of) logic behind the diagnosis.
If Richard would have called me BEFORE seeing the doctor (literally 5 minutes of his time), I could’ve:
He went for a consultation with a reputable private GP. Complained about chronic tiredness, stress through the roof and on top of that - insomnia. The doctor listened carefully and as soon as the conversation turns to insurance, she has dropped the classic line that triggers my eye twitch every time I hear it:
“Oh, you want to put this through your policy? I’ve seen it before — your insurer probably won’t cover it.”
Right.
Let me tell you the most common diagnosis I give to doctors - It’s an acute lack of knowledge about policy wordings with chronic complications of wanting to treat not just the health, but also the paperwork.
Richard left the appointment thinking - “What’s the point of this policy, if they’re just going to reject the claim?”
Here’s the part that frustrates me the most - the doctor wasn’t technically wrong. She had indeed heard of similar cases being declined. She just didn’t know why and that’s where the biggest issues lays.
Let’s review this situation one more time:
Richard told the doctor that (among a list of other symptoms) he couldn’t sleep well recently. The doctor has referred him for a course of CBT, stating insomnia as the primary issue in a referral. And guess what? His policy clearly excludes sleep disorders (which, by the way, is a fairly standard exclusion among all insurers).
BUT…
If that same insomnia was correctly documented as one of the symptoms of anxiety (or in other words a mental health condition) which IS covered — then suddenly we’re talking about a very different outcome here.
So no, the insurer wasn’t the issue in this case. The problem was how the referral was written and the (lack of) logic behind the diagnosis.
If Richard would have called me BEFORE seeing the doctor (literally 5 minutes of his time), I could’ve:
- Checked whether it’s an eligible condition or not
- Explained how to phrase the symptoms and ensure the referral aligned with policy terms
- Advised the exact steps to take - before, during and after the appointment
- But no — I usually get the call AFTER the rejection, with the classic: “Kirill, the insurer declined my claim. What should I do now?”
- And once I dive into the details of declinature and read the referral letter from the doctor, I’m thinking - “Mate, if you’d just called me first, you’d already be halfway through treatment by now.”
- Now don’t get me wrong — I have massive respect for doctors. They’re brilliant at what they do.
- But they don’t know the fine print of insurance policies. They often don’t know the difference between full and limited outpatient. Most have never seen an IPID in their life.
- And (even worse) some have absolutely no idea how to fill out referrals or claim forms in a way that doesn’t make the insurer fire off 15 different follow-up questions.
- And you know what? That’s totally fine!!!
- I mean, you wouldn’t ask the electrician installing your kitchen socket which provider offers the best commercial energy rates for your Mayfair office, would you?
- Exactly.
- So next time - don’t argue with your doctor. Just call your broker (assuming you have one. And if you don’t — you know where to find me
- )
- If any of this sounds remotely familiar — drop me a message. No pressure. No nonsense.
- Just a proper, unfiltered chat about what actually matters.