Northern Ireland pensioner with Bupa has to join NHS waiting list for heart surgery
An 85-year-old Bupa customer is back on an NHS waiting list for heart surgery after the insurance company pulled out of Belfast trust hospitals, it can be revealed.
The man, who has dementia, is now facing a wait of at least six months for the valve replacement surgery as an NHS patient - despite paying almost £8,000 to Bupa for private medical insurance for him and his 75-year-old wife in January.
The operation cannot be carried out at any of Northern Ireland's private hospitals as they don't have the intensive care facilities required when a patient undergoes such a procedure.
However, Bupa no longer refers its patients to NHS hospitals here, and the man, who first took out health insurance with the company in 1979, is too unwell to travel to an NHS hospital in England.
The insurance firm is now facing possible legal action over the situation and the matter is also to be referred to the Financial Ombudsman.
The pensioner's ordeal began in June this year when a pre-existing heart condition began to deteriorate.
He was becoming increasingly breathless and dizzy and, following a visit to his GP, he was referred for a number of tests and was told he required valve replacement surgery.
The cardiac procedure was available to Bupa customers at the Royal Victoria Hospital until April, when the firm temporarily suspended its recognition of all Belfast Trust facilities after it emerged it did not have the necessary medical negligence insurance.
However, Bupa did not inform its customers of the change and the public was only made aware of the reduced services when the situation was highlighted by this newspaper.
Lawyer Emma Fox of Fox Law, who is representing the man, said it was currently unclear what treatments were available through Bupa in Northern Ireland and that the company must clarify the position.
"My clients have paid a lot of money to have private health insurance that in the end has not provided them with what they expected it would when they needed it," she said.
"My client continues to await his treatment some five months on, while the effect of his condition has adversely impacted on his quality of life since June this year.
"If he had the treatment by now, he would be enjoying the things he was doing before.
"The whole matter has caused my client stress and anxiety.
"I'm in correspondence with Bupa to ascertain exactly what treatments and procedures cannot be provided in Northern Ireland.
"On behalf of my clients I will consider, when all the information is available to me, whether to commence a civil action for unfair inducement or misrepresentation to enter into the agreement."
James Sherwood, Bupa's director of health and benefits management, said: "We made the difficult decision earlier this year to temporarily stop sending our customers to NHS Belfast Trust because it does not have the medical negligence insurance in place to treat private patients in its hospitals."
He said it had apologised to the man as he "did not receive the correct information from us initially and confirmed that we will cover his travel costs".
He added: "If any Bupa customer needs treatment that cannot be carried out in Northern Ireland, we will cover the costs for them and a relative to travel elsewhere in the UK."
The man has also claimed that Bupa initially told him the company would pay him £240 expenses to travel to England, but then withdrew the offer.
After being approached by Ms Fox, a spokeswoman from Bupa confirmed that the company covered travel and accommodation costs of £240 per person and "would look to offer further support for a customer on a case by case basis".
Ms Fox said: "If someone has to book flights last minute, £240 isn't a lot of money."
The lawyer said she is referring the matter to the Financial Ombudsman.
She has also urged other Bupa customers who have been affected by the reduction in services available in Northern Ireland to contact her.