NHS Overseas Visitors charges

Hi, in 2018 and 2019 my husband and I visited the hospital to receive NHS treatment for infertility treatment, after being referred by the GP. I was at the time under spouse visa, and has paid the IHS surcharge as part of the visa application. In July 2021 this year, we suddenly received a bill for the treatment cost. This really surprised us as nobody told us, before, during, or after treatment, that there will be a cost. There was only a form that we filled in to state what my current immigration status was, to which we marked as having paid IHS surcharge. We have always been under the impression that we get free NHS treatment as would any resident.

After receiving the bill, we did a quick search on NHS website and found out that apparently in 2017, the rule was changed slightly to exclude infertility treatment as part of free NHS treatment for those who paid IHS surcharge, and would therefore be treated as an NHS Overseas Visitors charges. This is shocking to us that they can simply change rules without informing about the changes to those immediately affected by the change, and that in no part throughout the treatment were we being communicated about the treatment being chargable and what the costs would look like. Even more surprising is when the bill came few years after the treatment. We also read on the NHS site that they were actually supposed to inform us and make it clear if our costs are chargeable, and some clauses state that they should have taken upfront payment for non-urgent nature of treatment such as this. This way patients can make decision whether or not to proceed with the treatment. However, its not very clear what our rights are in this instance. Is it actually legal for them to charge us without having informed us early on that the treatment would be chargable? Can we refuse to pay on the basis that we were not made aware of having to pay for the treatment?

The NHS guidance we read are here:
https://assets.publishing.service.gov.u ... 021_v3.pdf

https://www.gov.uk/government/publicati ... s-visitors

https://www.gov.uk/government/publicati ... pital-care

To me, this does not sound like an immigration issue that we can guide on, as it is a very niche and specific healthcare charge issue.

I would recommend consulting a solicitor about this, though do make sure that they know enough about this niche topic before entrusting your issue to them.

Be aware that (a) this is a niche enough issue that many solicitors may not have knowledge of and (b) we have come across cases where solicitors have advised members of these forums incorrectly on immigration issues.

mysara81 wrote: ↑

Tue Aug 17, 2021 8:49 am

in 2018 and 2019 my husband and I visited the hospital to receive NHS treatment for infertility treatment
...
in 2017, the rule was changed slightly to exclude infertility treatment as part of free NHS treatment for those who paid IHS surcharge, and would therefore be treated as an NHS Overseas Visitors charges. This is shocking to us that they can simply change rules without informing about the changes to those immediately affected by the change

The government does not make every individual aware of changes to the law. The laws are published (online nowadays) and everybody is expected to be aware of the law. There is a presumption in law that everybody is aware of the law and therefore pleading ignorance of the law is no defence.

mysara81 wrote: ↑

Tue Aug 17, 2021 8:49 am

Can we refuse to pay on the basis that we were not made aware of having to pay for the treatment?

I doubt that you can refuse to pay on these grounds. Ignorance of the law is no defence. If you were not made aware of the fees, the law could very well expect you to ask about it.

mysara81 wrote: ↑

Tue Aug 17, 2021 8:49 am

We also read on the NHS site that they were actually supposed to inform us and make it clear if our costs are chargeable, and some clauses state that they should have taken upfront payment for non-urgent nature of treatment such as this. This way patients can make decision whether or not to proceed with the treatment.

What likely happened is that the doctors and nurses (being medical professionals whose focus is treating you) were also not aware that you would have to pay for the treatments. However, with the NHS looking for cost recovery due to government pressure, it is likely that your treatment bill came up during an audit of the relevant NHS trust and hence the late billing,

Thank you for your response and insight on this.

secret.simon wrote: ↑

Tue Aug 17, 2021 9:43 am

I doubt that you can refuse to pay on these grounds. Ignorance of the law is no defence. If you were not made aware of the fees, the law could very well expect you to ask about it.

I agree that ignorance of the law is no defence, but in this case we're not committing an offence or crime. We simply attended an NHS treatment referred to us by the GP. Whilst we should keep ourselves up to date with the latest rules, I would also expect the law would protect people like us from falling victim into situation such as this. It simply doesn't feel right to us when we are being suddenly slapped with a bill which no one told us about. Yes the law now state that infertility treatment is no longer free for IHS paying immigrants, but since there will now be charges I would expect the hospital would discuss with us that we'll be charged for the treatment, and what the charges would look like? It would affect the decision whether or not to proceed with the treatment, I mean imagine if the estimated charges would be in the tens of thousands! This is what I meant when I say whether we should pay having not being informed about the charges (not so much of the law change), especially after having declared we're paying IHS surcharge on a form that they provided to find out exactly this situation - if we're eligible for free NHS care.

mysara81 wrote: ↑

Tue Aug 17, 2021 8:49 am

in 2018 and 2019 my husband and I visited the hospital to receive NHS treatment for infertility treatment
...
in 2017, the rule was changed slightly to exclude infertility treatment as part of free NHS treatment for those who paid IHS surcharge, and would therefore be treated as an NHS Overseas Visitors charges.

From what I recall, the Immigration Act 2014 that brought in the required contribution to use the NHS (called the Immigration Health Surcharge) stated something along the lines that expensive elective treatment such as IVF (they mentioned IVF) would not be inculded in the IHS payment? The IHS started on 6 April 2015.

It seems from what you have said that the no free IVF on the IHS part, started in 2017?

From what you have posted before, your wife arrived on a spouse visa in December 2015 and then applied for FLR(M) in August 2018.
indefinite-leave-to-remain/ilr-eligibil ... l#p1958035

On the page, "Pay for UK healthcare as part of your immigration application" it states-

"You’ll still need to pay for certain types of services, such as prescriptions, dental treatment, eye tests and assisted conception."
https://www.gov.uk/healthcare-immigration-application

secret.simon wrote: ↑

Tue Aug 17, 2021 9:43 am

However, with the NHS looking for cost recovery due to government pressure, it is likely that your treatment bill came up during an audit of the relevant NHS trust and hence the late billing,

The Welfare State is doing the same: people are receiving bills of thousands for overpayments from decades before.

mysara81 wrote: ↑

Tue Aug 17, 2021 8:49 am

After receiving the bill, we did a quick search on NHS website and found out that apparently in 2017, the rule was changed slightly to exclude infertility treatment as part of free NHS treatment for those who paid IHS surcharge, and would therefore be treated as an NHS Overseas Visitors charges.

Unfortunately.

Your issues are that you can say you were not told of a fee for IVF, but you can't prove that, and the forms you have signed all state no free IVF, so the law would say you should have been aware/ had plenty of notification of charges for IVF.

The law would also say that it would seem obvious that something as expensive and non-life saving as IVF could be free after paying such a small amount towards the cost.

Sorry for your problem, how much is the bill? And is there anyway to spread the payment with the NHS?