Stamford Hill, London – Hundreds of Orthodox Jewish Families Left with Unpaid Health Claims

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    Stamford Hill, London – Hundreds of Jewish families claim they have been left out of pocket because a leading health insurer has failed to pay out for their treatment.

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    They are backed by angry dentists, opticians and chiropodists who say insurer HSA has failed even to respond to applications they made on behalf of the patients.

    Many of the patients are from large strictly Orthodox families in Stamford Hill, north London. They are furious at the lack of response.

    One community leader believes Jewish families are being “targeted” because of the large number of children on their policies, a claim that HSA denies.

    Ita Symons, head of the Agudas Housing Association in Stamford Hill, said: “It’s the first time I’ve heard of what appears institutional discriminatory behaviour in this country.
    “I’m shocked that such a company appears to be targeting the Jewish community, who signed up for policies in good faith and who rely on being reimbursed for treatments.”

    HSA said: “Our database does not hold details of ethnicity or religion, and any claim reviews would be based on an objective assessment of the facts.”

    One dentist says he is considering legal action after 50 of his patients were told they would not be paid for claims made via his surgery. The insurer said the dentist had not responded to letters requesting invoices, something he emphatically denies.

    Dr Baruch Davidoff, of Stamford Hill, is still trying to get a response from HSA, despite having sent several letters and emails. He said: “I sent out letters to the chief executive of HSA in March asking that they resend the ‘correspondence’ by recorded delivery but there’s been no response.

    “I recently sent emails asking for an explanation as to why no-one has communicated with me at any stage, but I just get bounced around by customer services. My questions aren’t going anywhere.”

    Homeopath Judith Posen has advised patients chasing for claims to “call them directly” after so many of her clients complained they were not being paid. She said: “HSA claim that they can’t pay out on treatments because I’ve not responded to their letters — but they’ve never written.”

    Michael De Jong, practice manager of Silverman Opticians, said: “Hundreds of my patients are owed money from HSA,” while chiropodist Steven Weiner said he had “never been contacted by HSA”, despite more than a dozen of his patients being told he had been sent correspondence.

    Dr Michael Horowitz, a Stamford Hill GP whose wife and eight children were insured with HSA, says he is owed £800 for treatments.
    He says a company representative visited his home in March and examined receipts and bank statements. He was even asked to show his children’s birth certificates.

    But more than a month later he was told by phone that his insurance £45-a-month premiums had been cancelled. They have still not received payment for treatments.

    He was one of several whose policies had been terminated after questioning why they had not been paid.

    Miriam Veiss-Fish received a letter in February telling her that her policy was under review after she queried non-payment of her £400 claim.
    She phoned customer services several times to be told it was “under review”.
    Last week she received a letter telling her HSA was cancelling her premium payments until further notice.

    HSA, which is part of the Simplyhealth group of medical practitioners, is attractive to Orthodox families because their Health Cash Plans provide insurance for “unlimited children” at relatively low premiums.

    Describing itself as having “helped people to access healthcare since 1922”, HSA promises to pay out on claims “within two days of receipt”.

    HSA said that it was “standard practice within the insurance industry to monitor claims and use external claims investigators where appropriate. This protects our business and our customers and also helps us keep premiums low.

    “If we identify cases where we are unable to obtain sufficient evidence to satisfy ourselves that the medical treatment the customer is claiming for actually took place, then we may refuse to pay the claim, and in some cases terminate the policy. In doing so, we are acting in accordance with our terms and conditions.

    “We encourage people with families to join our plan. If a customer is on a Health Cash Plan that allows them to claim for unlimited children, we would honour claims up to the annual limits, regardless of the number of children.

    “However, for each claim, we would need sufficient evidence that the treatment being claimed for actually took place, evidence that the children are living at the same address as the parents, and a valid birth certificate for each child receiving treatment.”

    The Board of Deputies has written to HSA, and said it was “extremely concerned to hear of the complaints that members of our community have made against HSA”. It has asked the company why “such a large number of claimants have had this problem”.


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    45 Comments
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    zalmen leib
    zalmen leib
    14 years ago

    this is not funny, times are very bad here in england we need our brothers and sisters to give us a hand

    Anonymous
    Anonymous
    14 years ago

    What happened to national health insurance?

    Anonymous
    Anonymous
    14 years ago

    RabosaiThere is no “free lunch” and anyone who signed up for “unlimited coverage” no matter how many children you have either knew or should have known there was a high risk in doing so. No legitimate insurance company can underwrite medical coverage over the long term for a family of 4 at the same price it charges to a family of 8 or 10 since it is obvious that the frequency of claims will be at least twice as high even if all other factors are held constant. (No acturary would say that when it comes to basic medical coverage under the UK supplemental health care system, the size of the family doesn’t matter)

    We heard the same crying of “gevalt” from those who invested with Madoff at totally unrealistic returns (in terms of their consistency not the yield) and then screamed for the government to bail them out when they lost their money. Both the HSA “unlimited coverage” and Madoff’s guaranteed “10 perecent per year returns” were obvious scams. As long as the bills were paid and the they were able to suck other unsuspecting yidden into the scam things were good. Now, they want the rest of us who paid the more realistic higher premiums all along to bail them out. Sorry, but go somewhere else. I’ve already paid my insurance premiums…now you go pay yours.

    yossi
    yossi
    14 years ago

    I always knew there is national health in England…Why do they need insurance for all those office visits which the government gives free of charge…? Something fishy here…

    Anonymous
    Anonymous
    14 years ago

    “Family” coverage in the U.S. is always for unlimited children. Why should it be different there?

    Anonymous
    Anonymous
    14 years ago

    In the US all health insurance companies have a family plan with a set annual fee independent of # of children. Only the Medicaid HMOs get paid by the govt per person and thus actually are paid much higher per family (in frum neighborhoods) than by paying customers

    Anonymous
    Anonymous
    14 years ago

    This is interesting information about national health care. Here in the USA President Obama wants to nationalize healthcare.

    Anonymous
    Anonymous
    14 years ago

    These poor yidden with big families took a risk by purchasing a cheap policy for extended care without a higher premium for more children. The article says that other insurance companies would never have written such policies and thats why they were popular with the frummies who thought they would get subsidiaed by the company’s other customers. I think poster no.1 said it correctly; there is no free lunch.

    US daughter, UK mama
    US daughter, UK mama
    14 years ago

    True story about the NHS in UK. My husband’s cousin was admitted to hospital erev Shabbos. There was no bed for him, he sat in a chair all weekend. He was dead on Monday. The NHS system is terrible & that is exactly the kind of thing that will happen here if they force socialized medicine on us.

    That is why so many people, as well as my family, have private health insurance. All except my mother, zol zei gezunt, who let her policy lapse after my father passed away & now she is in trouble.

    I want to bring her to the US for decent treatment, but can’t sponsor a 77 year old for citizenship. All ideas of how I can get Mama health coverage over here for a diabetic with heart problems will be gratefully received.

    Ben from Stamford Hill
    Ben from Stamford Hill
    14 years ago

    Sorry you are all wrong, HSA is not a health insurance. It is a Cash Plan which pays out for certain medical expenses like Optical, Dental, Chiropody etc, etc. You can read all about in on their website. hsa.co.uk. Basically you chose a level of cover which gives you a limited cash benefit for various medical situations both those that have cost you and even when this has not cost you, for example a hospital stay will give you a cash benefit even if done under the National Health System. What has happened now is that the company for whatever reason have decided to carry out a massive audit of the claims being made and in doing so hav probably realised that cartain policies are paying out way above the premiums being collected. They have devised a plan to cancel these policies by claiming that they have not been able to verify the recent claims, meaning that they have written to the health practitioner but have not received a reply. According to their rules if they are unable to verify a claim they are entitled to cancel the policy. The practitioners however claim that they have not received any correspondance from HSA. In addition they are refusing to divulge any information when questioned by individual policiholders under the pretext that the internal audit is still ongoing. At the moment we are aware that this has happened to a great many heimisher yiden due to the close knit community (mikve nies etc) we are in. But it may also be going on in the rest of the country. We need to start an action group where everybody who is involved should register their details so that we can get a full picture of what is happpening.

    Anonymous
    Anonymous
    14 years ago

    can you sue them in a class action suit?

    Anonymous
    Anonymous
    14 years ago

    Someone please find out if it’s only the yidden… I’m sure other large famillies (muslims) would be having the same problem? This needs to be established before we all start screaming on behalf of the Jews…

    Anonymous
    Anonymous
    14 years ago

    Anon. no. 4. Your comparison with Madoff is rubbish. It is HSA who thought there is a free lunch and that they could offer policies, take the premiums and not think about what were to happen if families with significantly more than 1.1 kids would take the plan up in large numbers. Like Hoover before them they are finding that their offer has overtaken them.

    Stamford Hill residents do indeed have large families and HSA’s offering of a blank cheque made no sense. But that is HSA’s problem and no one else’s. They are not the first and this is what happened with the the Swiss ‘chasene plan’ companies who learned to their cost that their model does not fit all and where there is an opportunity someone will spot it.

    drei
    drei
    14 years ago

    To a lesser extent the insurance companies do similar tricks in the US.Thier rates for reimbursement are far from “usual and customary”They deny claims for specious reasons hoping you wont get around to appeal.They require prior approval for many proceedure so they can deny full payment even if they would have approved it anyway..the list goes on

    Anonymous
    Anonymous
    14 years ago

    “American health insurance companies charge the same for a family no matter how big it is, so what’s implausible about an English company doing the same?”

    The large percentage of American companies that offer health insurance charge for singles, single plus spouse, single plus family care for up to -2 or 3 children and unlimited family coverage. The cost for more children is much higher unless you are in an HMO.

    Insurance Scam
    Insurance Scam
    14 years ago

    Everyone knows insurance companies often disallow claims. Allstate and State Farm have been sued by policy holders and State Governments in the Southern USA after they delayed and denied legitimate claims after hurricanes such as Katrina destroyed coastal residential properties. State Farm (like a good neighbor, State Farm is there !) claimed that all damage was due to flood waters, NOT wind or rain, so the lost homes are not covered under THEIR policy. Flood Policies are backed by a Federal Government plan and few homes are required to have them, and they often are for only a portion of the home’s value !!! So they were sued and sued and sued. Fortunately, they were found to be liars when evidence that the State Farm executives told their adjusters to LIE and DENY claims. So what is new? Insurance Companies collect money for policies and every claim that is made they lose that money. Why not deny them? Makes good business ! That’s why NY State is the most stringent to regulate Insurance Companies and around the US it is well known that if a policy is available in NY it must be legitimate. I hope that is true ! It isn’t for Madoff and the SEC, that is for sure….

    Forgedaboudet
    Forgedaboudet
    14 years ago

    Hello from london. Hsa is not proper medical insurance. It is a cash plan meaning that for every visit to a specialist optician etc. You get cash. If you have a baby you get the equivalent of your years premium. There is a limit how much you can get per year per treatment. In fact some people have it on top of their medical insurance which means that they get 2 receipts from the doctor send one to their medical insurance provider and the other to hsa having made a profit from their visit. Some people have 2 cash plans if you get my drift. Since most families have 2.4 kids and and a dog these plans have never restricted the amount of kids allowed on the plan. It’s basically free money and people know jolly well that it is. Also there have been serious abuses of the system. Any person who buys all his 13 kids new glasses every year will be struck off by hsa. So as a grateful hsa customer i suspect it was the abuse of the system that caused all this brouhaha. I have always despised my stamford hill brethren for not even being able to take free money in style and with panache.

    shimon taylor
    shimon taylor
    14 years ago

    The only thing HSA, or any health insurance is good for, is for earning money from its subscribers.
    They figure that most people will pay much more than the cost of services they will use, therefore they can afford to give a few people EVEN MORE than what they are paying for, but honestly, the HSA and the like can only do that AFTER they themselves have taken their good share from the kitty.
    Where else do you think the money is meant to come from!!!!
    Am I right?

    1
    1
    14 years ago

    The NHS really do the best they can no one gives them any credit.