By Spire Healthcare
Page last reviewed: February 2021 | Next review due: February 2022
Private medical insurance (also known as private health insurance) pays all – or some – of your medical bills if you’re treated privately.
Private health insurance is designed to cover the costs of private treatment for unexpected (acute) medical conditions. By paying a regular amount (premium) to an insurance company, you can avoid having to pay the potentially expensive, unexpected costs of treatment and gain access to fast medical treatment from your choice of the UK’s private healthcare providers.
Many insurers describe the types of conditions that they will pay for as those that are short-term and respond to treatment. They will not generally cover the costs of treating on-going conditions that you were aware of before you were insured.
It’s a personal choice to have private medical insurance. You may have private medical insurance if:
You can search for a suitable private health insurance plan online and on comparison websites. You can contact a broker who can guide you through available plans. You may even be covered through a workplace health scheme.
Many insurers describe the types of conditions that they will pay for as those that are short-term and respond to treatment.
Charges for hospital services such as nursing, use of facilities, medical consumables etc. The consultants - surgeons, anaesthetists and physicians - charge independently for their time and expertise.
Private medical insurers will usually not cover you for any conditions that were diagnosed, treated, or for which you sought medical advice before your insurance started.
They will also usually not cover the costs of treating chronic, incurable conditions. In addition there will be a list of exclusions on your policy – these commonly include GP services, prescriptions, cosmetic surgery and A&E admissions.
If you have private medical insurance, it’s important to check that your insurer will provide you with the authorisation you’ll need to proceed. The exact process will differ from insurer to insurer, but your policy information will confirm exactly what you need to do.
Step 1: Contact your insurer before booking an appointment so that they can pre-authorise your treatment.
Step 2: You will usually need to provide your insurer with a referral letter from your GP.
Step 3: Your insurer will check that your policy covers you to see the consultant you want or that has been recommended to you. If you have not been referred to a specific named consultant, your insurer will provide a choice of consultants to pick from.
Step 4: Contact the private hospital to book an appointment. You'll need to provide your insurer details, pre-authorisation code and consultant name when you get in touch.
Step 5: After the appointment, the consultant will write to your GP to update them on what they have found.
Step 6: If inpatient treatment is required, then admission is arranged, after which a follow-up appointment with the consultant will take place.
Step 7: Once your treatment has been completed, we’ll invoice your insurer directly. The insurance company will pay the invoice, apart from any excess on the policy that must be paid separately.
If you’re using private medical insurance, you’ll need an authorisation number from your insurer to ensure that any invoices from either the consultant you see or from the hospital, are sent directly to them to settle. The consultant will charge for their professional fees, covering their time and expertise to perform the procedure, usually alongside a separate consultation fee.
If you have an excess on your insurance, the insurer will pay everything to the hospital (and the consultant) with the exception of the excess. The hospital will invoice you separately for the excess.
Before your treatment starts, you’ll be asked to provide a credit or debit care to cover any additional extras not covered under your policy at the hospital. This could include:
In these situations, we’ll always receive an invoice from us before we charge anything to your card. If you wish to query anything in relation to the charges being made, please contact our customer services team.