How soon can I claim with private medical insurance in the UK?

[shell321]

This is a throwaway account for privacy reasons.

About three weeks ago, my partner and I signed up for private medical insurance in the UK. The bonuses and discounted gym membership (which we were already paying for) made it effectively free for us.

After just one week of being signed up I developed a tremor and cognitive difficulties. I'm not looking for a diagnosis, but I am terrified it is something like MS or ALS.

Obviously I want to get it checked out asap. If I was with the NHS, I would have gone after a day or two to see my GP. However, with a disease that can take a long time to diagnose, I would prefer to use my private medical insurance to speed the tests along.

My question: does anyone know how quickly I can begin claiming with my private cover?

I know in theory it is from day one, but if they believe I already knew I had the problem (which I didn't) they may decide to reject my claim. So we are torn between sending me to an NHS GP right away, just going to a private GP right away (and risking having to pay for the treatment out of our pocket), or giving it a few weeks to go to the private GP so it raises fewer questions.

My husband is hating this, and wants me to see a doctor right away. However, I think it might actually be a faster diagnosis if I wait a few weeks and then start the ball moving with the private medical care. Or, if the private medical care wouldn't mind about me seeking medical help within the first month, that would be my preferred option.

Does anyone have any advice? I can barely sleep with worry.

Right. First off, go to your GP. if this is a new medical incident presumably the checks the insurers might make would be to access your medical records and therefore they would only see you arriving at gp and telling them when the symptoms started I.e. after you had purchased insurance.

In my experience the cover I had (don’t have private insurance any more but did have BUPA. And another I can’t remember the name of) each expected my to get a referral via my GP first of all. So with dd, she had apnoea and got ENT referrral from GP to a consultant who dealt with private and NHS, and we provided insurance details to the consultant’s private practice who then billed the insurer. Likewise when I had throat issues, and with ds, he had eye problem and a referral from opticians. I believe there was of course also the option to direct book into a consultant’s list by providing credit card details as a self funded patient.

I suppose it would be worth ringing the insurer to ask how they expect the system to work I.e. how to trigger a consultant appointment.

But just because you have a private insurance policy doesn’t mean that you no longer use your gp - just means that if there are issues that need deeper assessment and medical referral you may then be able to use the private cover to get an appointment at a time that suits you.

NB I have a friend with ALS, diagnosed a few months ago. The NHS diagnosis was super quick - very quick referral and diagnosis.

My private insurance doesn't work in the way you suggest. As ^, I would need to go to my GP first and get a referral to a consultant, and then ring the private insurer to a) check the problem falls within what they cover and b) get a ref number for the subsequent treatment.

I've had private medical care since I started working 20 years ago and for something like this I would go straight to my NHS GP. You want to be in the system. If there are long waiting lists or you need to see a specific consultant, then would be a good time to invoke your private option. Depending on your plan you might need a GP referral anyway.

Just as an aside, if a private doctor prescribes you medication you have to pay the cost of the medicine, not the NHS prescription charge so that's always worth bearing in mind too.

Yes - Twitterqueen’s experience is that same as mine - GP first, referral, confirmation from insurer that will cover (I might have forgotten that stage in my response - was a long time ago) and then off you go.

Thank you for your advice everyone. This is the sort of information they should make readily available, as I clearly have misunderstood the process.

So you would advise me to see the NHS GP right away, and not worry at all about how it might look to the private insurer? This would be the first visit to a GP about this.

Or would you still advise maybe waiting just one or two weeks to make it more likely any private claim will process? I know the NHS is fantastic and I don't doubt they would do a great job treating me, it's just the waiting times can be a bit on the long side in some cases and I want a diagnosis asap to avoid going out of my mind. I don't think the anxiety this is causing me is helping much!

You need to check if there's a qualifying period before your insurance kicks in.

FWIW 'a tremor and cognitive difficulties' is not something you're going to get a diagnosis on quickly. It's far too general a description of symptoms. You will 'jump the queue' to see a consultant if you qualify under your insurance but there will still be tests, maybe scans, and a fair few weeks of waiting.

There may be a qualifying period on your cover - you will need to check this.

I’m either case you need to see your GP first - this is industry standard across UK private medical policies. Most specialists will require a GP referral before seeing a new patient.

Your insurer will likely want confirmation from your GP that your symptoms did not pre-exist your join date - if there is any indication that your symptoms were in existence before or at the start of your policy it is unlikely they will cover your claim, although this will ultimately depend on your underwriting terms.

You would need to start with a referral from gp, which could be a private hospital or nhs for tests etc. However once you have the options for referral speak to the insurer to see whether you are covered and if so for where/which consultant. There would be an excess to pay or you may have a qualifying period before you can claim at all.

You need to look at your policy documents. Some don't cover diagnostics, so you'd need to go privately or via the NHS for them.

Who is the cover with?

It is with Vitality. I believe I can request to be seen by one of their GPs, one of their video GPs, or my regular NHS GP which may have caused my confusion. As far as I can see in my policy details, there is no qualifying period.

If you've only got their core policy, have a look at the exclusions. More advanced diagnostics such as scans are not covered.

We are all covered for diagnostic checks, if referred by a specialist. I am just aware of how it might look to the insurer. In a way, it was good timing that we got the private insurance when we did. On the other hand, it was bad timing as I started showing symptoms so soon after, so we have delayed and not known how to handle the situation.

Which policy do you have with vitality?

They will ask you when you noticed symptoms so if you tell the truth it doesn’t matter if you delay

I’d go to NHS GP and get the ball rolling so your referral is made, call Vitality with accurate information and see what they say.

Hi OP I've PMd you x

I am unsure of my exact policy name but my partner says we are covered for the likely scans I might need.

You need to check yourself. The core cover does not include outpatient diagnostics, only inpatient.

Speak to your insurer before you incur any costs.

If you tell your GP exactly when your symptoms started, they will be able to confirm this to your insurer. If your GP doesn’t specify when the symptoms began, the insurer may potentially request your medical records (typically 5 years worth). The only thing to be aware of here is that their underwriters will also be considering associated symptoms or conditions.

The timing isn’t ideal, however it is what it is - is there ever a good time to make a claim? Speak to vitality, see what they say. Just make sure they give you the green light before you go to any private appointments

Even if you see your GP in 2-3 weeks, you need to tell them when the symptoms started. That date doesn't change irrespective of when you see the GP.

As others have explained you must see your gp initially. If GP says you need referral you can ask for referral letter for your insurers. I usually ask for an open referral rather than to a named specialist. You then contact your insurers and if they agree cover they will give you an authorisation number and put you in contact with booking for one of the specialists on their lists. You mùst provide your authorisation number when you attend for treatment. If you have a specialist in mind check the are on the insurers list as otherwise not all fees may be covered. There is probably a waiting time between policy inception and when you can claim though

My insurance covers from day one but does in so many words say they will look very carefully into any early claims and particularly anything in the first week or two.