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Private health insurance....what's the point?(19 Posts)
I have been considering private medical insurance as I've been pretty ill since having kids and was under the impression that it would speed up waiting times seeing consultants and maybe have more time spent with a gp who will investigate more things to find out what is actually wrong with me.
However, having just had a chat to bupa I now know that they will not cover pre-existing medical conditions or even symptoms at all so any symptoms that I have ever had in my life, if they re-occur then they won't cover them. Now, this covers a lot when it's looking at my entire life.
So what's the actual point of it? In reality is it actually like this? E.g, they will look back in your history and find anything that they can relate to a condition/symptom you are experiencing in order to get out of paying for consultation/treatment?
In practice, considering that many conditions have widespread symptoms, could you actually be told that your skin cancer won't be treated because you once got sunburn or your depression won't be treated because you once told your gp you were feeling down?!
I think it is normal if you take out private health cover as an individual that they do not cover pre-existing conditions. However, if you get it through a company scheme, it never has any exclusions so is really good.
Oh really? This would be through DP's work and I did mention that to the bupa person?
I agree with previous poster. Work schemes don't usually exclude previous illnesses.
Some work schemes do now - they vary a lot as obv its cheaper if they exclude existing conditions.
You'd need to get the terms of your DHs plan
Some company schemes have exclusions - some do not - it depends on the schemes (and the provider) and what is paid for by the company.
I must admit I have misgivings too. Dh has changed his work pattern so we recently had to change from the long standing company scheme to paying as an individual ourselves within this scheme and they would not cover ill health for me that happened during the life of the scheme (even though I did not claim- emergency treatment) as you say they exclude every system that has vaguely happened before! It is worth it for fit DH and Ds - but possibly not me.
We're in a company scheme and it's very much 'no questions asked'. Every time we've used it I've rung up and made very sure we'll be covered for whatever it is and they don't wnat any detail, they just say yes. I get the impression they don't want to rock the boat with big lucrative company contracts. However ours is Aviva not Bupa.
You do need to check the terms though as others have said.
Even if pre-exisiting conditions are excluded I would stll go for it if I were you as company schemes tend to be very good value. I had an op in a private hospital and it was so lovely I didn't want to come home The staff actually had time to chat, there was a lovely bathroom and the food was amazing. The medical care wasn't bad too
We have it through my husband and there's no exclusions.
I was very, very ill recently and needed an operation which I got within a week of seeing the consultant. I know people who had to go through NHS for the same op and have been waiting close to a year.
Obviously every policy and company will be different but I would say yes, it's worth it
You need to ask if the scheme is "medical history disregarded", in which case pre-existing conditions are covered.
Ours is Axa PPP. In every job my dh has ever had with health insurance it has been no exclusions. And always PPP. However, he works for insurance companies so maybe they always choose top cover!
ok, just found out it's Axa PPP business health exec program. Not looked into the policy yet
We have private health insurance through my husband's work. He has used it a lot more than I have. He has had two hernia operations, which were scheduled quickly, and at a time convenient to us (NHS wait is about 6 months). He has had counselling for depression, again a long wait on NHS. We've both had physiotherapy. He's recently had a cataract operation. He saw the consultant a few times for various measurements, etc, and had the operation four days after the final check up. Op took place in very nice surroundings and he was given the consultant's mobile number and told to call with any problems.
The big one that made it worth it for us though, was when I found a lump in my breast on a Monday morning a couple of weeks before Christmas. I saw the GP that day, saw the consultant on the Wednesday and as it was a cyst, had it drained there and then. If we'd gone NHS, there would be a two week wait, which would have taken us up until possibly Christmas eve. Two days wait was bad enough (strong family history of breast cancer, so pretty scary).
It's not cut and dried OP.
Most insurers cover you for 'acute' conditions that arise- not chronic (long term ones) simply because that's more expensive for them; they don't pay out money for on-going conditions, once you have received treatment. (If symptoms returned then you'd have to go to the GP with it and then ask insurers if they'd cover you. If they said 'you had treatment for this 1 year ago and the claim was closed' then they may not cover you again.
However, some insurers have a 2-year rule; they will cover an existing condition either after you have been with them for 2 years (if you need new treatment for it) or if you have not had any treatment for an existing condition for 2 years when you sign up with them.
An example of this; my insurers (company scheme) paid for 2 DEXA scans (bones) - one then a follow up one 2 yrs later, but they will not continue to pay for them every 2 years forever (which is how often they are done.) So I pay myself (it's about £190.)
They are tightening up all the time to avoid people using it for chronic conditions rather than ones that are one-offs and sorted with an op or other treatment.
why don't you self insure yourself - put aside a decent amount of money each month.
When something crops up - see your gp. If it needs a consultation with a specialist you can then use the money to see someone privately if the waiting list for that consultation or treatment is really long.
This assumes you have a good relationship with your gp practice - if not then maybe use the money for private gp consultations as well - but be aware they may be more likely to refer you onto 'their friends' as there will be a monetary interest in it if the gp is private.
I am part of AXA PP through a very big company scheme. However its not always clear (to them!) what will be covered. Acne for my DS, hair loss for me weren't covered but they messed up the claim and ended up paying quite a bit of it in the end.
I wouldn't be without it but when I retire will do as lovefairy says and put some money aside should the need arise.
If you are ever given duff info they record the phone calls which is why they paid out for two recent claims..
love you don't need to 'have a good relationship' with a GP to get referred if you are paying. You simply say you want to see X consultant and could the GP please write a letter (and not all consultants require this anyway.)
Some GPs charge £20 or so for doing the letter.
It's okay to save up - a consultation is around £250 max in Harley St- but some blood tests are £600 (rare but happens) and operations are up to around £10K. You can usually find the cost of ops on private hospitals' sites.
Even when a company excludes pre-existing conditions, they'll often have a moratorium period.
So if your pre-existing condition doesn't flare up/reoccur during the first 2/3/5 years of the policy, they will then cover it.
I have been on a 'no pre-existing conditions' policy through work before, because the
cheapskate company was in the process of being sold and wanted to massage the books on staff costs. They changed back to a no-exclusions policy after the sale went through!
But one person who had hurt their knee running was told that their policy wouldn't cover anything in that one leg, so the exclusions can be absurd depending on the underwriter.
Depending on the company, you might not need a written referral letter before they will authorise treatment. When I need physio, I phone them up and they do an assessment over the phone, which takes 5 mins and has always resulted in them authorising 10 sessions of physio.
Other times, I've phoned up to authorise an appointment with a consultant, they've asked if I've seen my GP, I say yes, and they authorise it. I may or may not have seen my GP first, but they don't ask for anything in writing and a lot of consultants don't need a referral letter.
Other times, I've phoned up to authorise an appointment with a consultant, they've asked if I've seen my GP, I say yes, and they authorise it. I may or may not have seen my GP first, but they don't ask for anything in writing
Aren't you at risk of not being covered?
Our insurers ask for the GPs details on a form and may well contact them.
My own consultant told me that legally, insurance companies can demand to see your medical records (ie the consultant's) so they (the dr) can't try to fake treatment and diagnoses which would allow them to be paid!
OP - rather than talking to the insurers, does DP's employed have an intranet site that you could look at? That would give you details of their programme, which would tell you a lot more.
Ours is through DH's employer - I compared, and his was better value than mine
and that way he pays and we have never had any issues. They have paid for the physio of our choice (the one who will go to school) for DS without a murmur - they just checked her name was on professional registers - which is more than I expected. Whenever we have claimed they have been helpful and responsive (but we both work for very large companies which may affect this...)
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