Published August 2024
Am I covered?
The medical insurance market is becoming increasingly difficult to navigate and our members often ask us if they are covered by their insurance for the treatment they have had or are about to have.
Insurance companies that once had very broad and open policies are becoming more restrictive not only in what procedures and treatments they cover, but also in what consultants/specialists and hospitals are covered. To ensure that your health insurance policy continues to meet your personal needs, it’s important to check what you are actually covered for and how to claim.
Each insurance provider offers different plans, and even with a single provider, there can be multiple tiers of coverage with restrictions added year on year whilst premiums climb. The policy that you started with may well have morphed into one that is no longer fit for your individual needs.
What do you need to check?
Approved lists vs. un-approved: Many “big name” insurers now have an approved list of consultants and hospitals. Sometimes not all consultants within a hospital will be on the approved list. If you have a particular hospital or consultant in mind, make sure your policy covers it.
Coverage Limits: We are seeing more insurers capping the amounts they will pay out for a particular medical treatment, or parts of the treatment. For example limits on initial or follow up consultation fees, overnight stays, medication costs, surgery fees.
Exclusions: Exclusion of a pre- existing conditions and certain life-long illnesses and diseases can be commonplace. Sometimes medical costs are only covered for the first year or two. Other plans have blanket exclusions for certain conditions regardless of pre-existing conditions, most commonly mental health and cancer treatments.
Pre-authorisation: The need for prior authorisation codes is commonplace. It is important to understand the correct claim procedure you need to follow in order to make your claim valid.
Referral for scans and tests from a GP: It’s worth checking if your policy covers GP requested scans and tests. There are one or two health insurers now who will only authorise payments if they have been A) pre authorised, and B) requested by a specialist consultant on their approved list.
Thankfully, in the UK, there are plenty of health insurers to choose from. It seems obvious, but it really is worth spending time comparing your coverage against what else is available on the market and against what your current and likely future health needs may be. Like all insurance policies, it is worth looking around for the best deal.
Do I need it?
Health insurance policies give you some protection against the cost of private diagnosis and treatment. Whether this is valuable or necessary depends upon your own circumstances. Many of our members, faced with spiralling insurance costs, have chosen to ‘self-pay’, putting aside their monthly premiums to spend on any future needs. Private hospitals and specialists often offer reduced rates for self-pay patients. This approach is worth considering as, in certain circumstances, the numbers do add up.
Help us to help you
To make your private referral and ultimately your claim as smooth as possible, please let us know who you are insured with, and if you can, please let us know of any notable restrictions on your policy. Our referrals team work with hospitals and consultants on a daily basis and have built a fountain of knowledge to help our members navigate this increasingly complex landscape.
By advising us who you are insured with, our referral team is able to check directly with hospitals and consultants before booking any appointments. If we don’t have all of the information we need, then our team will get in touch. This will help us to get it right first time.
For Concierge Medical Members
Did you know that, as a member of Concierge Medical, you have exclusive access to the Concierge Medical Private Health Plan, underwritten by the HMCA. We have negotiated with HMCA Members to offer discounted rates for private medical cover exclusively for Concierge Medical Practice Members.
The plan covers over 550 hospitals country-wide and there are no restrictions on consultants or specialists. The plan also covers diagnostic tests ordered by your Concierge GP. For further information and quotations contact HMCA by telephone on the dedicated Concierge Medical enquiry number 01423 798190 or visit the website here: https://www.hmca.co.uk/concierge-medical/