Using your Private Medical Insurance

Spire Healthcare hospitals are open to everyone, whether you are insured or not.

Contact your insurance company to check that you are covered for your planned treatment, including your first out-patient appointment.

In order to obtain treatment funded by an insurance company you will need to:

  1. Obtain a referral from your GP
  2. Confirm cover with your insurer at each stage of your treatment
  3. Provide details of your cover and authorisation for treatment to us

Obtaining a GP referral for treatment funded by an insurance company

Simply visit your GP and ask them to refer you to a consultant who practises at your local Spire Healthcare hospital. Your GP will write a letter of referral and then either you or your GP can contact us to arrange your first out-patient appointment.

Your insurer may require your GP to complete some sections of a claim form. Your GP may make a nominal charge.

Once you and your consultant have agreed on the treatment needed, we will arrange your admission for a time that fits in with your other priorities and commitments.

Confirming cover with your insurer

You are responsible for the costs of your treatment so it is important you understand the cover your insurer will provide.

The best way to ensure your insurance company will cover your treatment costs is to contact them prior to each stage of treatment, including your first out-patient appointment, to inform them of your treatment details and confirm cover. Click here to access contact details for popular insurance companies.

Claims processes differ from insurer to insurer and your insurer will guide you through the process. If your cover is provided by your employer you will follow the claims process specific to your scheme.
Your insurer may require a claim form from your GP (see below) and will need to check in advance with your insurance company that you are covered for treatment at each stage (e.g. outpatient consultation later followed by day-case surgery).

Billing and payment

Spire charges for hospital services (nursing, facilities, medical consumables etc).
Consultants (surgeons, anaesthetists and physicians) charge independently for their time and expertise.

Spire has direct settlement arrangements with insurance companies and will normally submit our charges to them electronically. In order to do this we need to know:

  • Your insurer
  • Your registration number
  • Your scale/level of cover
  • Your scheme details if you are insured under a company scheme
  • Your pre-authorisation number for your treatment

We will ask you for a swipe of your credit card when you register. This is to cover any charges your insurer is not liable to pay. Your details will be kept securely for up to 6 months and we will notify you in advance if is necessary to use them.

Consultants may invoice to your home address and it may be necessary for you to forward bills to your insurer

Useful tips

  • Contact your private health insurance company and check that you are covered for the planned treatment, including your first out-patient appointment. Obtain a claim form if required by your insurer
  • Obtain an authorisation code from your insurer and advise the Spire patient administrator of this when you attend hospital
  • Check your policy for any limits on the amount you can claim on certain types of treatment. Most policies will have an annual excess and limits, for example, on the amount payable for outpatient treatment
  • Bring your policy documentation with you even if you have attended a Spire hospital before.
  • If your insurer requires a claim form:
    - Bring your claim form with you when you attend your first out-patient appointment
    - Inform the Spire patient administrator if you have a claim form and it is already with your consultant, GP or insurance company
    - If you are being admitted for in-patient or day-case treatment, please hand your claim form to the patient administrator so that we may arrange for the medical section to be completed by your consultant.
    - Make sure you have completed and signed the "patient/member" section on the claim form.
  • To make things easier for you we have direct settlement arrangements with the major UK insurers and your insurer will normally settle your bills from Spire and your consultants direct. You will need to pay any insurance excess or shortfall. 

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Advice on choosing private medical insurance

The Association of British Insurers (ABI) publishes a free guide to purchasing medical insurance, designed to help you understand more about how private medical insurance works, so that you can make an informed choice before buying a policy. Visit www.abi.org.uk.

FAQs

For more information about how private medical insurance works, see our PMI Frequently Asked Questions page

© Spire Healthcare Group plc (2014)