Going private if you have health insurance

There are many different types of private health insurance from family plans to limited or specialist cover. One of the first things an insured patient should do is to check with the insurance company that they are covered for the necessary operation or treatment, the outpatient consultation or tests, and then request a claim form.

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Most private health insurance policies do not cover patients for pre-existing conditions, chronic long term conditions that cannot be cured, or NHS services such as accident and emergency services and ante-natal care for a normal pregnancy.  Treatments such as cosmetic surgery and breast enlargement, alcohol, drug abuse or HIV/AIDS treatment, rehabilitation, sex changes, kidney dialysis, experimental treatments and drugs and organ transplants are also excluded as an NHS patient.

Most health insurance companies (and many consultants and specialists) require a GP referral to “authorise” your treatment. This may also be a requirement of the consultant and the private hospital/clinic who will need to know about your case history.  The general process for insured private patients is as follows:

Your GP recommends a consultant or specialist and writes a private patient referral letter. (Sometimes the GP will charge for this.) However, you can do some research on the specialist whom you want to be treated by, and can ask your GP to refer you to a specific consultant. 

You contact your insurance company to check that the operation or treatment is covered and to obtain authorisation for treatment. They will check that both the hospital and the surgeon are covered by your health plan.

You attend an out-patient appointment with the consultant where relevant tests are carried out (or are booked for a later date), and your treatment is agreed with the consultant. Outpatient, daycase or inpatient treatment is then booked at a time and date that is convenient (or no further treatment is necessary).

Following outpatient treatment the consultant writes to your GP to update him or her, and the insurance company settles the hospital and consultant bills, informing you of any shortfall which must be paid. 

For inpatient treatment, the date is booked, you are admitted to a private hospital and again the consultant sends an update to the GP. You attend a follow up appointment with the consultant and your insurance company settles both your consultant bill and the hospital bill and will inform you if there is any shortfall to be paid. The process is the same if no further treatment is needed (i.e. the GP is updated and any fees are settled).



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