20/07/20 (3) A message from AXA

Not long after finishing the 'phone consultation with Dr.Ch I had an email from AXA-PPP telling me there was a message on the website. It's to do with the complaint process that I started when they were refusing to fund the return to Zometa a few weeks ago. Here it is, edited down to the important stuff:

----------------------------------------------------------------------

 

Following your call on 18 June, your concerns about our refusal to cover Zometa infusions were passed to me.

My role is to look into your complaint and see whether we have treated you fairly and in line with the terms of your membership. Having completed my review, I don’t believe we have which means I am upholding your complaint. 

Our records show that you contacted us on 18 June. You informed us that Dr Ch recommended you should revert to Zometa infusions, instead of the oral equivalent, due to the side effects you were experiencing.  We advised that we could pay for the infusions only whilst you receive chemotherapy and that we were therefore unable to authorise your treatment. Having completed my review, I don’t believe our decision was correct and I trust my letter helps to put things right.

 It might be helpful if I first explain that you are covered under the terms of the Personal Health plan and the benefits and limitations of this are detailed in your membership handbook. On page 26, we explain that even though generally we do not pay for out-patient drugs or dressing there are exemptions for drugs given for cancer treatment. In particular, on page 24, we specify that “We cover drugs you need to support you whilst you are having chemotherapy or biological therapy to kill cancer cells. For example:

•bone strengthening drugs such as bisphosphonates or Denosumab

•Hormone therapy that is given by injection (for example goserelin, also known as Zoladex)

•Anti-virals, anti-biotics, anti-fungals, anti-sickness and anti-coagulant drugs.”

As you are receiving biological therapy in the form of the drug Lenalidomide (Remvid) we can pay for infusions of bone strengthening drugs, like Zometa.

I am sorry you were misadvised on 18 June and I can reassure you that feedback has been provided to avoid the situation from reoccurring. I was pleased that, later that day, upon realising the error we contacted Dr Ch to authorise your treatment and that we also managed to speak to you on 22 June to inform you that we could pay for the infusions. I note that you contacted us on 25 June, after receiving a letter of acknowledgement of your complaint, and I was pleased that you informed us that you considered the issue resolved.

I hope my review and the action I have taken resolves your complaint. However, if I am mistaken then I need to tell you that you can now refer your complaint to the Financial Ombudsman Service.

You have the right to refer your complaint to the Financial Ombudsman Service, free of charge – but you must do so within six months of the date of this email.

--------------------------------------------------------------------------------                                                                                  

So that's a win and I can continue to be very happy with AXA-PPP. Good, because the last thing I'd need right now would be looking to change insurers!   .