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How to use private health insurance

Private health insurance is the most popular way to access private healthcare, yet the process of using it is not always clear.
How to use private health insurance
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The following information is applicable to patients living in England, and being treated in England. No information provided should be taken as formal legal or medical advice.

Similar to other types of insurance, like car insurance or home insurance, private health insurance can be used to access private healthcare services without paying for the full cost of treatment. Some of the UK’s largest providers of medical insurance are Bupa, Aviva and WPA, with each offering a variety of policies with varying levels of cover. While each insurer has different processes, this guide outlines the likely steps you need to take to make the most of your insurance.

1. Check your policy

Not all insurance policies are the same, and so it is very important that you consider your policy’s terms before receiving private treatment. To do this, you should first read through your policy documents. You can then contact your insurer to clarify any terms you do not fully understand.

Key things to consider are:

  • Are you likely to be covered for what you wish to be seen for?
  • What is the excess policy?
  • Do you need a referral to the service to be covered for it?

Medical bills can be extremely high, and are hard to predict. Therefore you should not commit to a service/treatment without being aware of the likely costs. If for any reason your insurer refuses to pay the healthcare provider, you may be liable to cover the cost. When you are seen by the provider, you can be asked to provide a payment method upfront in case this happens.

2. Find the service you’d like to access

The second step is to decide where you would like to receive treatment. This could be a certain consultant, a certain clinic at a given hospital, or an MRI scan at a certain location, to name just a few examples. Importantly, private services can vary greatly based on price, care quality, quality of facilities and waiting times. Therefore, you should always bear this in mind when making your decision.

For example, the price of the service may affect how much excess you will be expected to pay, where your policy requires this.

Importantly, many healthcare providers will have pre-approved agreements with insurance companies. If they do, this means that they can interact with the insurer directly, reducing the administrative burden on you, and reducing the likelihood that your insurer will reject your request. If you would like to find out if a provider is approved by your insurer, you can contact your insurer or the healthcare provider directly.

3. Get a referral to this service

If your insurance policy requires that you obtain a referral to the service before you are treated (this is quite likely), you should go to your GP (NHS or private) and ask for a referral. When doing so, you should make clear your reasoning for why you would like the referral, and that it would be for a private service. Your GP is under no obligation to provide the referral, and can use their discretion to decide whether it is medically appropriate. If you’re already under the care of a doctor for a related condition, then you may be able to obtain a referral from them, preventing the need to go to your GP.

4. Get an authorisation code

Having received your referral, you should now seek authorisation from your insurer before accessing the service. To do so, you should follow the processes required by your particular insurer.

Often, this will entail calling your insurer to explain your situation. You may then be asked to send them your referral documentation.

Once approved, you will receive an authorisation code. When requested, you can then give this code to the healthcare provider. The code helps show them that your insurer has approved the treatment, and it can allow them to bill your insurer directly.

Note: your code will likely just cover a predefined scope of treatments, and therefore you should keep your insurer informed of any changes in treatments.

5. Be seen

With the approval from your insurer, you can now go ahead and contact the provider you have been referred to, arranging an appointment as appropriate. You can now be seen.

6. Keep your insurer updated

You should keep your insurer informed about your care, including developments in the treatments you will receive. This is to ensure that they can give you up-to-date advice, thus preventing any misunderstandings which could leave you out-of-pocket, inadvertently picking up the bill.

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