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Private Medical Insurers




Choosing a Medical Insurer

Selecting the best policy to suit your needs is complex and difficult. The seductive advertisements and brochures may not make the detail and small print within the policies obvious. The information may not be clear in respect of as to any company well they will manage your claim, to what extent they will pay all your claim or allow you free choice of your own selected specialist. Each insurance company may  provide a multitude of different policies each with specific advantages, disadvantages inclusions and exclusions. To help you choose a policy we have used our experience to attempt to identify the advantages and disadvantages of each. Browse through our information and advice on the best providers.
The various providers of Private medical Insurance are listed below with our rating and comments together with contact details.

Personal Private Medical Insurance

Why go Private for your Treatment

You can get private health treatment for any medical condition, providing you can pay for it. This could include treatment in a private hospital, by a medical specialist or GP. It could also include dental treatment, counselling and psychotherapy, physiotherapy, or treatment for drug or alcohol abuse.

You might want to get private health treatment when:

  • the treatment isn’t available on the NHS. For example, cosmetic surgery
  • there’s a long NHS waiting list and you don’t want to wait
  • you want to choose your surgeon or specialist
  • you do not want a trainee surgeon or specialist
  • you want to choose the date for a hospital operation
  • you want to be treated at the hospital of your choice
  • you want a second opinion on treatment or the advice you’ve had on the NHS or from another specialist

How to choose? – Ask your GP.

It is often promoted that the reason for seeking private treatment is the environment of a private hospital or the quality of the food. However on must remember that the overwhelming reason should surely be to obtain the best medical outcome from treatment. This relies primarily on the choice of specialist, the facilities available to them and the success rate. In terms of surgery this usually relates primarily to a low complication rate, low infection rate. Whilst in respect of cancer treatment 5 year survival and cure is highly relevant, in respect to orthopaedics and joint replacement the 5 or 10 year revision rate or incidence of deep infection is most important.

The insider advice from the medical profession is that the most important factor above all else is the access and availability of a specialist in the particular area of medicine which is appropriate who is an expert in their field. This is very difficult to discern for the general public without inside medical knowledge. This is because of many factors. Whist the local expert is a good starting point within the NHS appointments are made at an Early stage at the completion of training, may not be wholly based on experience or expertise, NHS appointments are generally for life and not reviewed, The local expert becomes the local NHS appointee generally automatically becomes the local expert for private practice. Data on a particular specialists treatment outcomes is now available on the internet. However the available data on success, survival and infection rates is generally not specific, accurate and often not relevant for the medical problem or procedure needed. As an example if an orthopaedic surgeon is an expert in treating elderly patients, patients with rheumatoid arthritis, diabetes, or hip arthritis then he will have a much higher incidence of DVT or venous thrombosis, pulmonary embolism and fatal complications as compared to a surgeon specialising in hand or shoulder surgery.

Much of the internet data available for the private sector is collected by the medical insurance industry or private hospitals; each with their own vested interests. In particular insurance companies will often promote, publicise or highlight on their web sites or through their “helplines” consultants who have signed up to be associates, preferred providers or “recognised” which generally means – have accepted a lower fee in exchange for a potential higher number of patients directed to them by the insurance company.

What then is the answer for patients to make their choice. Most specialists would suggest the best, most reliable and impartial place is to ask your GP who is the expert he would go to for the particular problem or diagnosis. Be aware that some insurance companies now promote as a benefit a “helpline” to call before being referred. This is then used to direct patients within the insurance companies selected cohort of specialists. In many instances this has resulted instances where knee problems are directed by the insurance company to other specialists such as a shoulder surgeon.

It is important to know that some special procedures of a specialist nature, which may need specialist equipment, intensive care or are of a certain complexity are best treated in a local all encompassing NHS facility. To ensure that the overriding concern is of a successful medical outcome irrespective of the facility, you should ask and be guided by your GP and specialist in this.

Before getting private treatment, you might want to think about:

Whether you can afford it. The cost may be surprisingly high. A telephone call to the specialist of your choice or the local private hospital will willingly provide a general estimate of the costs of treatment. Once you have undergone an initial  consultation and assessment an accurate estimate of the “fixed Price Surgery” or “Self Pay Procedure” is readily available in writing. As a general range of the costs. The initial consultation fees are in the range of £150 to £250. X-rays if necessary may cost from £100 to £350 and an MRI scan from £250 to £750.

If you have private medical insurance you should inquire as to what the level of cover is. Try not to allow the medical insurer to direct, arrange or organise your treatment. This is generally to practitioners and facilities of their choice which may be directed to saving costs. It is in your interests to seek the advice and a chosen specialist from your GP first and ask you insurer to authorise that referral.

Private medical insurance generally only guarantees to cover the whole cost of treatment where you have the treatment at the facility and with the specialist of their choice or approval. Other specialists, often more senior, recognised or busy practitioners may charge a higher rate which may or may not be covered in full by your particular medical insurance policy. Most people are not aware that most providers of medical insurance have polices which provide for different levels of cover in respect of specialist fees; from a minimum cover only for their selected practitioners, to policies which cover for all the costs with whichever specialist you choose. These differences and options are often not highlighted at the inception of the policy, not generally well understood, but is usually associated with payment of a higher a higher premium.

Corporate or Buisness Private Medical Insurance

Corporate Medical Insurance

Medical insurance may be provided by your employer or company. The employer often has the power of scale to negotiate preferential rates, extent of cover or for the payment of all medical specialist fees of your chosen practitioner without any shortfalls. Where there is any dispute often the company manager can resolve the issues more easily than occurs with personal insurance policies. However, the inland revenue treats the benefit of the policy as taxable and adjustments will be made within the tax you pay. Generally, it is beneficial to have a corporate scheme. Difficulties may arise when leaving a company, changing jobs or insurers where cover for recent problems may be reclassified as pre-existing to the new insurer and excluded.

Woldwide or Expatriate Medical Insurance

Private healthcare abroad

You may want to have private health treatment abroad, either because it is cheaper than the cost of the treatment in the UK, or it is only available abroad, or because you are moving abroad to live. Do your research and make sure you know what the risks are. If you work abroad or travel intermittently then expatriate medical insurance will cover the costs of private treatment abroad; often at a much higher level of cover and with fewer restrictions than when seeking treatment in the UK.

Travel Insurance

Travel Insurance

Travel insurance generally does not cover for medical treatment abroad unless as a result of an injury or illness contracted whilst abroad. The small print often excludes all pre-existing conditions or illness, even where the injury, problem or illness may have been many years previously or could have been foreseen. The insurance company will often seek to analyse your GP records before providing reimbursement. Often the cover will only provide for the equivalent of NHS treatment and not private treatment or from the specialist of your choice whist abroad. Often the insurer will encourage you to return to the UK for treatment and may cover the costs of repatriation rather than treatment abroad. Be aware that travel insurance will then not cover for the treatment in the Uk as this will be provided by the NHS.

Frequently Asked Questions about medical insurance in the UK

Do I need insurance to get private medical treatment ?

No. Private treatment is always freely available. Indeed, in practice this is the best way to ensure total freedom to chose the practitioner of your choice, the hospital or facility and time of your choice. The costs are competitive and therefore telephone and ask your selected specialist for a quotation for the initial consultation, MRI scan or the cost of the procedure as a “Self Pay Patient” of a “Fixed Cost Patient”.

Can I contact a specialist directly ?

Yes. The telephone number or increasingly the e-mail address of your selected specialist is available on the internet. A GP referral is not essential however this is always a good idea as the GP may be able to refer you to the best experts for your problem in the local area. Some insurance companies may insist on a GP referral or GP knowledge of the consultation. Some insurance companies seek to direct your treatment from specialist “partners” often to save costs. Increasingly Insurers may seek to “manage” your care and direct you to their selected specialist rather than allow the GP with his local knowledge and experience to do this.

Which insurance allows me to choose my own consultant ?

This is a very important and vexed issue. Traditionally your GP was relied upon to use his medical experience and local knowledge so as to be able to identify who in his opinion was the best local specialist to deal with each particular patient’s problem. However with generic referral patters within the NHS GP’s have become a little less knowledgeable about the various special expertise of the local specialists. However this remains independent and impartial from financial gain. Conversely providers of medical insurance are increasingly seeking to circumvent the local GP making a referral to a particular specialist of their choice or that of the patient. The “managed care” model encourages patients to first contact their insurance “helpline” who will direct patients to the insurers selected cohort of “partners”. These are usually clinicians who have agreed to restrict their charges in exchange for the insurers “recognition” and more patient referrals.

Within the medical profession the advice would be to rely upon your local GP of allied medical specialist (eg local consultant, physiotherapist etc) rather than an insurer’s “helpline”. However once you have identified your chosen specialist and hospital you should check with your insurer as to what level of benefit they will then cover.

Some insurance companies are much more advanced in implementing this “managed care” model such as BUPA and AXA-PPP. Others allow patients much more freedom in choosing their specialist and in covering their medical fees without “shortfalls”. These may include WPA and Exeter Healthcare.

Which insurance allows me to choose my hospital?

There are many hospitals and facilities providing private medical care. They are all available to patients who wish to pay for their private care. The Care Quality Commission regulates them all. However many insurers restrict the hospitals their patients may utilise in particular polices. Generally this is perceived to be based on costs. This creates a “preferred provider Network” of hospitals. This may be very restricted on cheaper and more restricted policies and open and unrestricted on executive, corporate of premium medical insurance policies. Some insurers have a more inclusive range of hospitals than others do. WPA and Exeter healthcare are perhaps more inclusive and allow more patient choice.

Which is the best medical insurer ?

This question has many facets. A recent survey was circulated which claimed that 75% of medical specialists would recommend WPA to their patients as the medical insurer of choice. WPA has a less restricted network of specialists and therefore allows greater freedom of choice for their insured patients. The claims process tends to be much simpler with a significantly higher level of remuneration allowed for the medical specialists. This allows WPA to utilise a wider number of specialists and allow more choice and possibly explains why WPA is preferred by medical specialists.

Exeter Healthcare is another easy to use medical insurer. It does incorporate a moratorium whereby pre-existing conditions are covered after two years have elapsed and that the premiums are only increased across all patients groups evenly and not particularly for older and higher risk patients. For many other traditional insurers such as BUPA and AXA-PPP the premiums may rise exponentially with age over 65 and rapidly become unaffordable unless the policy is downgraded to provide a lesser level of cover.

Who do doctors use for medical insurance ?

This question has many facets. A recent survey was circulated which claimed that 75% of medical specialists would recommend WPA to their patients as the medical insurer of choice. WPA has a less restricted network of specialists and therefore allows greater freedom of choice for their insured patients. The claims process tends to be much simpler with a significantly higher level of remuneration allowed for the medical specialists. This allows WPA to utilise a wider number of specialists and hospitals with less administration which possibly explains why WPA is preferred by medical specialists.

What can I do if my insurer tells me which specialist I should see ?

Identify which specialist you have chosen and why. If possible seek a referral from your GP to the specialist of your choice. All insurers should recognise all medical practitioners registered with the General medical Council. The only question should be to what extent the insurer will cover the hospital and specialist fees. Your selected specialist will also be able to tell you what the “shortfall” will be between the remuneration to be expected from the insurer, and the medical specialists fess to be charged.

What is a policy excess ?

As for all insurance policies there may be a policy excess. This may be a sum defined at the inception of the policy of perhaps £100. In some co-payment schemes the excess may be as high as £1000 or a percentage of the charge (eg: 10% or 20%). The policy excess may be payable by the patient in respect of the first consultation or treatment received.

What is a shortfall ?

A shortfall is the sum of money between what an insurance company will pay in respect of treatment and the fees charged. This may be a sum in addition to the policy excess. The fees to be charged by a specialist are readily available once an initial consultation and assessment has been undertaken. A request should be made from your insurance company as to what level of remuneration they will pay in respect of any consultation fees, or the proposed procedure of operation. This can them be compared to the specialist fees proposed.

Am I responsible if my insurer does not pay ?

The person receiving the treatment is liable for the costs of that treatment. Where the treatment is covered by medical insurance the patient remains responsible for the medical fees should there be a policy excess, there is insufficient medical cover, where there is a shortfall on the medical specialist fees or when for whatever reason the insurer fails to pay the specialist fees. The extent of medical insurance and specialist fees should be checked and are readily available once the nature of any surgical procedure had been identified.

How do I find the best specialist for my problem ?

Within the medical profession the advice would be to rely upon your local GP of allied medical specialist (eg local consultant, physiotherapist etc) rather than an insurer’s “helpline”. However once you have identified your chosen specialist and hospital you should check with your insurer as to what level of benefit they will then cover.

Some insurance companies are much more advanced in implementing this “managed care” model such as BUPA and AXA-PPP. Others allow patients much more freedom in choosing their specialist and in covering their medical fees without “shortfalls”. These may include WPA and Exeter Healthcare.

Many patients rely upon word of mouth from friends or relative: “He was so nice…”. However every patient’s problem is different and demands individual treatment which may result in different outcomes. For example the result from a easy uncomplicated hip replacement may not be the same if one patient has osteoporos, Padget’s disease or a congenital deformity. In addition, the clinical expertise rather than bedside manner should not be forgotten as perhaps the most important factor.

Am I covered for follow-up appointments ?

For self pay and uninsured patients the first follow-up appointments and sometimes the costs of any immediate complications may be included. Subsequent follow up appointments once discharged may be charged separately.

Follow up treatment is generally covered. Some insurance companies such as AXA-PPP have sought to restrict the number and frequency of follow up appointments allowed rather than rely and allow the discretion of the treating practitioner. Follow up may only be allowed by some insurance companies for a set period of time; usually a period at which they expect full recovery to have occurred. In orthopaedic surgery longer term follow up  of joint replacement patients on an annual basis may be preferred by your surgeon. This may not be allowed for by some insurance companies but is important in detecting early remedial problems.

Am I covered for physiotherapy ?

Most medical insurance policies have an allowance for physiotherapy whether as the initial treatment of for rehabilitation following surgery. The allowance may vary dependent on the level of insurance cover, the policy details and the insurer chose. Additional physiotherapy may be directed by your specialist, which may necessitate payment over and above that provided for by your insurance policy.

Am I covered orthotics, braces and supports ?

For self pay and uninsured patients the in-patient physiotherapy, splints, braces and supports is generally included. For insured patients this is usually charged to the insurer within the hospital account. However as an out-patient whist the costs of a consultation with a podiatrist or physiotherapist may be covered any splints, braces, insoles or orthotics prescribed or provided will generally not be reimbursed by the insurer and the costs will be payable by the patient.  The costs of custom made orthotics or knee braces may be significant and should be checked before purchase.

Am I covered to see a podiatrist ?

For self pay and uninsured patients all the costs of podiatry treatment will be charged. For insured out-patients, up to the defined policy limits, the costs of a consultation with a podiatrist or physiotherapist may be covered up to a specified limit. However the costs of any splints, braces, insoles or orthotics prescribed or provided will generally not be reimbursed by the insurer and the costs will be payable by the patient.  The costs of custom made orthotics may be significant and should be checked before purchase.

Am I covered to see a chiropractor, osteopath or homoeopath ?

For self pay and uninsured patients all the costs of chiropractor, osteopath or homoeopathy treatment will be charged. For insured out-patients, up to the defined policy limits, the costs of a consultation with a chiropractor, osteopath or homoeopathy may be covered up to a specified limit as for physiotherapy. However the costs of any splints, braces, insoles or orthotics prescribed or provided will generally not be reimbursed by the insurer and the costs will be payable by the patient.  The costs of homeopathic treatment is not generally included in medical insurance policies.

What happens if things go wrong with private treatment ?

All patients at all times can revert to being an NHS patient and ask to be transferred to the nearest NHS facility. For certain complications patients may be transferred to the local NHS hospital for emergency treatment or complications. Thus for patient safety there are contingency measures in place providing for the emergency cover for patients in a private hospital. In addition private hospitals generally have resident on call medical junior cover and the consultants are available 24/7 and should respond to any request from the hospital in respect of emergency assistance for their in-patients.

For self pay and uninsured patients the immediate costs of the treatment for complications directly associated with the planned surgical procedure may be covered by the hospital under the terms of the “self pay” or “fixed price” package contract. This also sometimes covers patients for such associated complication for a period of 30 days. The wording of the contract should be checked. For insured patients the costs of additional treatment of complications which arise whilst an in-patient of following discharge are usually covered under the terms of the insurance policy.