What is private medical insurance?

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.

Why do people have private medical insurance it?

It’s a personal choice to have private medical insurance. You may have private medical insurance if:

  • you would prefer not to wait for NHS treatment
  • you just don’t want to use the NHS and would prefer to stick to private hospitals where possible
  • you want to be covered for drugs and treatment you can’t get on the NHS, like specialist surgery for sports-related injuries

How do I get private health insurance?

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.

What is covered by private medical insurance?

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.

What is not covered by private medical insurance?

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.

How does private healthcare work?

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.

Using private medical insurance at Spire Healthcare

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:

  • Any excess on your policy
  • Where you’ve reached the maximum payable for certain parts of your treatment – eg physiotherapy or drugs that you take home after treatment
  • Other incidental expenses, such as visitor meals

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.

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