Health insurance - How does it work?

[HeathIns]

I've had private health insurance for my DC all their lives and never had to use it. DD now needs to see a consultant (not cancer) and operation.
I don't have private health insurance myself so don't know how to use it.
The doctor is referring her to a consultant (NHS) but what do I do with this insurance?
Sorry to be so thick. I've name-changed out of embarrassment!

You usually have to ring the insurers first who will then give you a list of consultants you can use usually at a local private hospital. They often then arrange the consultation etc There will be an excess of around £200 to pay but then usually all costs covered from that point

If you decide to go with the NHS and not claim you can usually get £100 per night back in cash for each overnight stay in hospital

Thank you!
I'm not sure of exact details. DD went alone to the doctor and returned saying that she was being referred and will need an op.
Should I just contact the surgery and let them know she has private ins.? I could contact the insurance company but not sure what to tell them as DD hasn't seen the consultant yet for full diagnosis.

Yes, if the surgery know the gp can write a referral letter to the relevant consultant. Does the nhs one do private locally or.you can ook up on website of the private healthcare which specialists use local hospitals and should be covered. Once one has agreed to see her you will need a case number to charge it against. There is usually an excess and an annual limit.

Great! Thanks! I'll phone the surgery tomorrow and tell them. I think the consultants are often one and the same person...private/NHS? Just different hospital and waiting times?

You ask the gp to write a referral to a private hospital (there may be a charge for this which generally the insurance won’t cover).

Depending which insurance company you are with and where you live there may be a limited number of consultants who will accept your policy without top up fees.

A few policies (more common in ROI) will require you to pay up front and then reimburse you unless the hospital have an agreement in place with the insurer.

I would start by calling your insurance company and explaining the situation, they will guide you how to proceed in a manner which works for your policy. If you want to see someone other than their suggestions (which will be whoever works out cheapest for them) it should generally be possible but may increase extra costs.

Thanks Asdf12345 !
I was expecting to pay an excess but I was unaware of extra fees!
I thought all treatment was paid for under the policy! There are exemptions but none of them apply to DD.
Yes, I'll phone this insurance company too and see what sort of policy my DD has and what is covered.

I don't think exemption is the right word! I mean things that aren't covered under the policy. Exceptions?

Not all policies have an excess, mine doesn’t. Look up consultants at local private hospitals who specialise in what your daughter needs doing and ask for recs on a FB group / amongst friends. Then call the GP and ask who they recommend or tell him who she wants to see. Unless you’re in central London pretty much all consultants will be covered by most insurers. Then ring the insurance company and tell them you have a referral. They’ll give you an authorisation number and usually that’s all you do. You give the number to the private hospital when you make the appointment and they deal with it all.

Yes , preexisting conditions or cosmetic procedures for example may be excepted. There may be a cap on treatment costs such as physio. If you choose a consultant not on their list, or are referred on to one at a hospital of a different provider, cover may be limited on their fees, above which you pay.

Thank you both, very helpful.
This would be a non-urgent (not life threatening) but necessary surgery which is available on the NHS. I wouldn't bother but I've paid this insurance for 17 years and now would be the time to use it.
It seems like a load of hassle though!
I'll contact Surgery and ins. company and see what they say!

Honestly it’s really not a hassle. 10 minutes and it’s all done.

@Atrixie

Honestly it’s really not a hassle. 10 minutes and it’s all done.

I think the main problem is that the GP is referring DD to a consultant for a proper diagnosis/ plan of action so I don't really know what to say to the insurance company! I'll ring them though!

Just ask about the referral for now. If there are tests or treatment proposed you just call again.

Insurance companies are used to members calling not exactly sure what to do. If you can let them know the situation and they can advise what steps you would need to take to be able to use the insurance.

@LIZS

Just ask about the referral for now. If there are tests or treatment proposed you just call again.

I will do! Thanks!

Rose I hope so! I sound like a bit of an idiot really. Luckily, it's never been needed and I've never thought about it but 17 years of premiums add up and I might as well try and use what I've paid for!

Few if any private hospitals are actually doing private work, they have been used to do what little elective surgery the NHS is doing.

100% - I say that as someone who works for one of these companies lol - we don't bite and are happy to help talk you through the process.

They also often pre authorise certain things like the consultant appointment and any tests that may be needed - you'd then let them know if you needed more
The advantage would be she will probably be seen quicker than nhs and for the op will have a private room

We've used our AXA PPP insurance many times and it's covered pretty much everything (we have a £100 per person per year excess).

Our current process is that the GP has to write an open referral letter (i.e. a to whom this may concern rather than a named consultant). I often do a bit of research online to find a few specialists I think look appropriate and then call up AXA to check they're covered. Ours is a corporate policy and is less generous than it used to be so I try to stick with consultants from their affiliated hospitals (BMI for AXA). Alternatively they have a "fast track" team that can source a consultant and make the appointment for you.

They then authorise your initial consultation and any related tests over the phone and give you a claim number. Once you've had your first appointment and know you need xyz, you call them again so they can update your claim and confirm it's covered. You could also check the surgery is covered in principle before you see the consultant.

I have to say that I've found the claims team to be very helpful and it's usually a quick and painless 10 minute chat on the phone,

I should add that I don't think I've ever paid for treatment to be reimbursed, AXA has always settled direct (though I've had to provide credit card details when booking as a back up.)