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Going private if you have health insurance

Heres 2 health medman

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 procedure/treatment/outpatient consultation or tests, and then request a claim form.  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 & Emergency 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. 


Once you have confirmed your health insurance cover, you need to see your GP; most health insurance companies (and most procedures) require a GP referral. This helps the consultant and the private hospital/clinic familiarise themselves with your case history.  The general process for insured private patients is as follows:

  • Your GP recommends a specialist consultant 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 treat you, and can ask your GP to refer you to a specific consultant. You can search our database of over 2,500 UK private consultants.

  • You contact your insurance company to check that the referral is covered and obtain an authorisation reference.

  • You attend an out-patient appointment with the consultant where relevant tests are carried out (or booked for a later date) and either an outpatient/inpatient treatment is booked (or no further treatment is necessary).

  • Following outpatient treatment the consultant writes to your GP to update him/her,and the insurance company settles the hospital/consultant bill, 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 hospital/consultant sends an update to the GP.  You attend a follow up appointment with the consultant and your insurance company settles both your cosultant's 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. GP updated, fees settled).


If you have private health insurance go to ‘What to consider' next


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