(UK) Can a health insurance provider see any records of you visiting a private Dr if you opt out of sharing your data w/your GP?

[Humminngbirrd]

I visited a private GP recently (paid out of pocket) about a newly developed health issue and opted to not share my records from that visit w/my GP. I would now like to take out a private health insurance policy as a backup to NHS care (had been planning to do this before this condition developed as I just turned 45, but now of course would ideally like this condition to be covered under the policy),

Would the insurer be able to see somewhere that I visited a private GP before taking out the policy? I assume this will be considered there is a pre-existing condition if they could see I sought care for something.

Pre-existing conditions are not covered.

This is a helpful guide.

www.aviva.co.uk/health/health-products/health-insurance/understanding-medical-underwriting-types/

You can't get insurance for a condition you already have and is being treated.

They will usually ask if you have seen a dr (any dr) within a certain period of time and what it was for.

Insurance is for new and acute conditions. It's for things like surgery to treat something which under the NHS might mean a long wait. It's also there so you can choose your consultant and have appointments as and when it's convenient.

There are also a lot of conditions that need ongoing treatment indefinitely, and these would not be covered except for an initial diagnosis.

I know pre-existing conditions won’t be covered. Which is why I’m asking if there is a way of them knowing if I don’t tell them (e.g. through any healthcare database which shows I sought care somewhere private, even if I don’t share with the GP).

I know this is not necessarily kosher but this condition started as I was just about to sign up for insurance just to have as supplemental care to NHS care as I’m now 45+, so the timing was just unfortunate.

I have no idea if or how they might access your medical records through a private GP.

However, if you want private cover to 'supplement' NHS care, it sounds as if you are already getting some care via the NHS.

If it's a long term condition, it won't be covered anyway with private insurance.

You can access investigations, a diagnosis, surgery , physio etc. But not long term.

For women, menopause is not covered, in case it's that.

So you want advice on how to get away with insurance fraud?

What Violettaa said.

If it's long term treatment rather than a diagnosis and surgery, no insurance will cover that anyway.

Explain maybe?

If you go ahead with the insurance and the paper trail is never discovered, surely that means you will have to use the insurance to see another private consultant to have the [same] diagnosis that you have already had from the private GP?
S you'd have to go along and pretend you didn't know what condition you have and not reveal you'd seen a dr about it already.

Are you doing this - or hoping to - to jump the NHS queue for surgery?

Why is being over 45 relevant?

Really depends what it is.

I had horrific periods which I'd been to the GP for many times over the years.

I had my ablation done privately which was covered by insurance despite the heavy periods being in my files for years.

It can be slightly a grey area sometimes as @Twizbe said.

Friend of mine got a referral from a long term insurer to a gynae as her periods became heavier in her late 40s. She wasn't covered long term for treatment (drugs) but she was covered for the consultations and a scan.

Now of course, her GP ought to have (and am sure they did) give the date of when she saw them about it. If she'd said she'd noticed the symptoms for 3 months before seeing the GP, that's fine (as it's reasonable to wait before seeing a dr, sometimes). If she'd said 5 years, then maybe not.

It was regarded as normal menopause symptoms so cover could not continue for those particular symptoms.

@JinglingHellsBells
Actually the contrary, I’m doing this to not have to rely on the NHS at all if i can help it. After seeing how things have changed with cuts to the NHS over the last 10 years (and witnessing friends go through issues with late diagnosis and treatment causing more health issues) I told myself I would feel better getting private health insurance after 45 since i’m getting older and I wanted to start looking at more preventative care (regular cancer screenings, etc). I was just in the process of shopping around for policies when this health issue reared its head unexpectedly and I needed to get it seen to right away. So thats what I did.

The insurance would be for any specialist treatment and surgery (this condition would be likely either taken care of through medication or surgery with a private clinic/hospital). And when I say have NHS for backup, this is for general things like health checks, smears, etc when they are due to me. I actually have a great amount of respect for the NHS and if I can afford to pay for health care to both get the optimum care for myself while also taking strain off the NHS, then I’m happy to do that but I think it’s also fair that I have my regular health checks through NHS since I pay my taxes. It’s just unfortunate that these insurance companies are not allowing for pre-existing conditions. Even in the US - where insurance companies are a racket - coverage of pre-existing conditions is now required by law. If insurance companies would allow that here now, it could help alleviate the strain on the NHS.

We have private health insurance through my husbands work and like you we've used it for my op and GP appointments for DH.

For the kids and usual screenings we are happy with NHS.

We can free up nhs space by using private.

Back to your question, all you can do really is ask what an insurer consider a pre existing condition. Like I said, technically my heavy periods were a pre existing condition (had been that way since the first one at 12) but they covered the operation.

I've developed a new varicose vein in my other leg. I will be having it out at some point in the future. I suppose they could consider that pre existing as I had one removed before 🤷🏼‍♀️

This is interesting as I’m having this same issue (sudden heavy bleeding) but this is not the condition I’m reffering to and I assumed this is just my cycle having one last hurrah before winding down (this happened to my Mum in menopause). Anyway, I wouldn’t expect anything to do with menopause to be covered tbh. Although I did hear that BUPA has a special plan which covers menopause and HRT. I suppose if the menopause was bad enough, it would be worth getting that plan. I’m not really there yet, at least I dont think!

Oh right ok. I misread @JinglingHellsBells comment about your post before seeing yours and thought it said you weren’t covered. So that’s very interesting and great that you were able to get coverage. Would you mind me asking which insurance provider this was with? I’m glad you were able to get the surgery to put an end to the issue. That must have been a great relief!

It’s just unfortunate that these insurance companies are not allowing for pre-existing conditions. Even in the US - where insurance companies are a racket - coverage of pre-existing conditions is now required by law. If insurance companies would allow that here now, it could help alleviate the strain on the NHS.

The trouble is that you want to pay for insurance not ^care.
^
You insure against something that may or may not happen, so the costs of it are pooled amongst everyone buying the policy. That's why PPs are mentioning things like heavy periods - many women will have those without needing treatment/ never being diagnosed with anything.

If you know that you have a specific condition already, insurers won't 'bet' on you to not need treatment for it.

You absolutely can pay for care - any private hospital will let you pay direct - but that will be far more costly as you won't be subsidised by people who took out a policy that they then don't need.

It's different in the US where there isn't a backup. The agreement the insurers have (effectively) is that they get a guaranteed market in return for providing limited social goods.

@Humminngbirrd it's BUPA and I remember my DH saying that they were really 'banging on' about women's health when they presented the benefit to them.

I know he pays more via salary sacrifice to cover me and the kids.

They didn't bat an eye lid when I phoned to get the authorisation for treatment. Perhaps because it was a one off surgery ... I dunno.

I'm confused by your posts @Humminngbirrd

I completely agree with you, by the way, that the NHS is very slow and treatment can be delayed.

But I'm not sure if you are fully aware of how insurance works? Maybe I've misunderstood your posts, so apologies if that's the case!

You say you want more preventative care and screenings etc.

I told myself I would feel better getting private health insurance after 45 since i’m getting older and I wanted to start looking at more preventative care (regular cancer screenings, etc).

This is not available on insurance unless you have symptoms. You can get private screening through a referral to a consultant (if they think you need it) if you have symptoms. BUT it has to be kicked-off by a GP referral if the insurance is going to cover it.

You can self-refer for many types of screening or appointments (with a consultant) without a GP referral but you would self-fund them.

You can also pay (self-fund) for any treatment (surgery etc) at a private hospital. Most of them publish the cost of common operations on their websites.

What sort of screening are you thinking it might cover, if you are happy to carry on with the NHS for smears and mammograms?

The BUPA menopause cover is £250 (so I've read.) It covers an appt or two with a private GP (usually remote) and any prescriptions needed. These may be paid for at cost, or the NHS may pick up the cost if the private GP writes to your NHS GP. The £250 is annual. It's like a helpline, with meds provided if you need them.
It won't cover investigations or any surgery needed.

Actually I think you are just not aware that there are policies out there with options. The policy I’m looking at allows for optional add-ons (which you pay extra for) for things like: genetic cancer testing and preventative surgery (if necessary) if you are at high risk for cancer due to cancer in the immediately family. It also allows for prescription meds for certain behavioural conditions which tend to not be as easily or as quickly prescribed on NHS. As I said, you do pay extra, but there are such options.

You didn't explain your need to test for inherited, genetic conditions. If you are a woman, you must be talking about elective breast surgery, hysterectomy, or ovary removal.

That's something totally different to maybe expecting a test for (eg) bowel cancer, just because you feel the NHS doesn't offer it as much as you'd like, or more frequent smears, or only if there are worrying symptoms.

It would be easier to get accurate advice here if you said why you saw the private GP.

IF you now have a diagnosis, and want treatment privately, you are going to have to lie because to see a private consultant using insurance you would need to see a GP (although a private one is accepted too) . Insurance companies insist on a GP referral as the starting point. They ask for the date when you first experienced symptoms and the date you saw the GP. The GP has to fill in the paperwork.

Actually I think you are just not aware that there are policies out there with options. The policy I’m looking at allows for optional add-ons (which you pay extra for) for things like: genetic cancer testing and preventative surgery (if necessary) if you are at high risk for cancer due to cancer in the immediately family.

What's that got to do with your main question?

In your first post, you said you'd seen a private GP, and would your diagnosis be on record (and accessed by insurers) so you could hide it in order to be covered?

Add-ons for anything else whether it's genetic testing or menopause are not really the question you asked.