Private treatment if you have health insurance

There are many types of health insurance cover available to patients, from family plans to very specialised and personalised plans. The first thing anyone with private health insurance needs to do is review their policy details and speak to their insurer to get confirmation that their health insurance is set up to cover the necessary operation, treatment, test or consultation. If the appropriate cover is available, then request a claim form to start the process.

It is important to be aware that, with a lot of insurance policies, there are certain instances where cover may not be provided. Some of these instances include pre-existing conditions, long term chronic conditions that are uncurbable, A&E services or pregnancy care. Cosmetic surgery and other elective procedures are quite often excluded from private health insurance policies as they’re deem non-essential procedures. Treatment involving drug abuse, rehabilitation, dialysis, organ transplants and experimental treatments are not available either as these are categorised as NHS services.

In most cases private health insurance companies will request a GP referral before they can approve treatment. This may also be a requirement by the private hospital or clinic that will carry out the treatment, depending on the type of treatment needed.

The typically the process for privately insured patients to get treatment includes the following:

  • Your doctor will provide a referral letter to a consultant or specialist they deem appropriate for the treatment you need. If you prefer, you may do your own research to find your own private care provider and request a referral there.
  • Contact your insurer and inform them of your situation and get confirmation that your policy covers the treatment you need. Following this, the insurance company will do their checks to see if the hospital or clinic, and the surgeon, are covered by your policy.
  • An appointment to visit your consultant is arranged. They will carry out all necessary tests, discuss the procedure and agree on the treatment. A date and time is booked, as convenient for all.
  • Following the procedure, the consultant will write a report to update the GP and insurance provider. The insurance provider will pay the consultant and hospital bills and provide you a summary. If there are any outstanding fees for which you’re not covered, you will be informed.
  • On any follow up appointments, the consultant will report any updates back to your GP as per usual. Costs of both the consultant and hospital will once again be settled by your insurer. Like before, any fees that are not covered by the health insurance policy will be notified to you.

This is generally the process of receiving private healthcare with health insurance, however the process may differ depending on the treatment needed, the specifics of the insurance policy and the hospital or clinic carrying out the procedure. It is extremely important that you’re well prepared ahead of receiving treatment. Be sure to consult your GP and got approval from your insurance provider so you’re confident about what is and isn’t covered by your policy. This will ensure that there are no nasty surprises or unexpected bills to pay at the end of your treatment.

Copyright MHC Digital © 2019. . All rights reserved. | Mhc Digital does not provide medical advice, diagnosis or treatment. The information on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing doctor.

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