PRIVATE MEDICAL INSURANCE FAQS

 

Frequently Asked Questions

1. My Insurer says that you are too expensive

This is their way of saying that the surgeon that your GP has recommended is not part of the loyalty scheme that your insurer promotes. Some surgeons are members of loyalty schemes and agree to set their prices at a level dictated by the insurer. Some, then receive a Bonus as a reward. It is more transparent and fair to charge all patients the same, irrespective of insurer or, whether they are insured or not.

2. My insurer says that you are not on their list of specialists (or not ‘recognised’ by them)

Again, this is their way of saying that the surgeon that your GP has recommended is not part of the loyalty scheme that your insurer promotes. Instead, the surgeon probably charges fees that are the same, whether you pay yourself, or are insured with any private medical insurer or mutual fund. To charge different patients, different amounts (according to what the insurance company will cover) for the same procedure, is unfair and could be challenged by the Office of Fair Trading.

3. My insurer insists that I cannot see you, but have to go elsewhere

This is the insurer’s method of diverting you away from the Surgeon that is both recommended by your GP and local to you too. The insurer prefers that you see a member of their loyalty scheme and possibly, pays that doctor a bonus for charging less. You may wish to ask your insurer some questions:

– Does the doctor they have suggested have the same level of skill and experience as the one your GP recommended?

– Do they have your medical interests or their ‘profits’ in mind when suggesting that the specialist your GP has suggested is inappropriate?

4. The amount I will have to pay seems a lot – why?

Some insurers have recently made huge reductions (up to 50%) in the amount that they will reimburse to their clients who are claiming for treatment. Medical charges have NOT increased – in fact, fees that doctors charge (and insurers reimburse) have barely increased over the last 15 years despite increases in RPI and inflation.

5. Why was I not told that my policy does not actually cover the cost of treatment?

Insurers have not told their policy holders that they are suddenly meeting less of the costs. In effect they have levied a massive excess upon you, the policy holder, with no consultation or warning. If your car insurer did that, you would likely change insurance company.

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