A woman seeking almost $100,000 from Lloyd’s after she argued a US hospital had a debt recovery company pursue her for medical expenses has lost a claim dispute.

The feud came about after Lloyd’s was able to negotiate a substantially lower bill amount than the hospital originally invoiced.

After accepting her claim in March last year, Lloyd’s received hospital invoices for medical costs for $US108,876 ($146,419). Via a US cost containment service provider acting for the insurer, this was negotiated down to $US35,189 ($47,324) and paid.

The policyholder argued she received insufficient communication from Lloyd’s and was “hounded” by debt collectors from overseas for the original higher invoice amount.

She went to the Australian Financial Complaints Authority (AFCA), saying she was owed the difference between the original invoice and the amount Lloyd’s paid - $US73,687 ($99,072).

AFCA determined that Lloyd’s had reimbursed the hospital all that was required and “there are no grounds for the woman to claim she is entitled to the difference between the amount she was invoiced by the hospital and the amount paid by Lloyd’s”.

“I accept that there would be some frustration by the complainant given the situation and circumstances. I do not accept that this means the claim was not handled adequately,” AFCA said.

“There is no outstanding amount payable on the claim. The insurer has met its obligations under the policy.”

The woman and her late husband had purchased a year-long XYZ Travel Plan policy from Lloyd’s starting in May 2018. In February 2019, he became ill in the US and was admitted to hospital and the woman’s March 2020 claim was submitted for all the costs associated with his medical treatment, accommodation and out of pocket expenses.

Lloyd’s told AFCA that claim was accepted and resolved and nothing further was required.

“There are no monies owing to the hospital. Accordingly, there is nothing for which to make a claim,” AFCA ruled. “Lloyd’s was able to resolve the invoice with the hospital and this means there is nothing outstanding.”

The woman said she was pursued by debt collectors and only found out the hospital invoice had been paid at a lower amount after later discussions with Lloyd’s. Documents in mid 2019 from Switzerland requested the woman authorise communication between the provider and Lloyd’s and explained that if her claim was denied, she would need to pay the original six-figure invoice amount.

AFCA acknowledged she was followed up for payment by an agent of the hospital but said this would not have caused “an unusual amount of stress or inconvenience”.

“The letter from the agent for the hospital is reasonable and does not show the constant pursuit by them,” AFCA said. “She was being advised of her potential liability in the event of the insurer denying the claim.”

See the full ruling here.