Private Healthcare

[DJFish]

I'd imagine self diagnosis/referral isn't the most reliable method.

[The_Doc]

DJFish said:

I'd imagine self diagnosis/referral isn't the most reliable method.

The specialist (Private Consultant or whatever) bills for the consultation. This is an unchallenged or authorised invoice to the insurance company if you self-refer. So the GP or other healthcare professional acts as a gatekeeper for the expensive outpatient consultation. If not the insurer would have a decent chunk of invoices to pay, representing wasted appointments or mis-directed appointments. They are SUPER strict about what they pay out for. In many cases they control suppliers charges, like a Supermarket paying a farmer f**k-all for milk.

Also they can screen out problems and refer on to the correct private specialist.

Do you know your HPB surgeon from your oncoplastic surgeon?

You have shoulder pain after big meals...... GI surgeon or Shoulder surgeon?

[Sheepshanks]

12TS said:

I also moved jobs and found the quality of cover was reduced and that I had to get a referral note approved by the insurance company every time I needed something. My docs charged me £40 per letter and I had to wait a couple of weeks, net result PITA. For something big you'd clearly go through it.

I've never been charged for a referral and I got one over the 'phone recently, faxed to the private hospital for the consultant, done within a few minutes. The way NHS funding is channelled through GPs now, I thought it saved the your local service money if you go privately.

What was a bit daft is the insurer wouldn't accept the GP referral for an MRI, it had to be requested by a consultant. So I had a 5 min consultation, which cost the insurer £250, just for the consultant to say "you need an MRI".


This business of being seen instantly has never worked for us. Maybe it would if you were prepared to travel and didn't have a particular consultant in mind, but for us it's generally been a matter of waiting a couple of weeks or so as the consultants only do the odd private clinic and get booked up.

Edited by Sheepshanks on Thursday 25th May 17:30

[The_Doc]

Sheepshanks said:

12TS said:

I also moved jobs and found the quality of cover was reduced and that I had to get a referral note approved by the insurance company every time I needed something. My docs charged me £40 per letter and I had to wait a couple of weeks, net result PITA. For something big you'd clearly go through it.

I've never been charged for a referral and I got one over the 'phone recently, faxed to the private hospital for the consultant, done within a few minutes. The way NHS funding is channelled through GPs now, I thought it saved the your local service money if you go privately.

What was a bit daft is the insurer wouldn't accept the GP referral for an MRI, it had to be requested by a consultant. So I had a 5 min consultation, which cost the insurer £250, just for the consultant to say "you need an MRI".


This business of being seen instantly has never worked for us. Maybe it would if you were prepared to travel and didn't have a particular consultant in mind, but for us it's generally been a matter of waiting a couple of weeks or so as the consultants only do the odd private clinic and get booked up.

Edited by Sheepshanks on Thursday 25th May 17:30

(Some) GPs over order MRIs and the insurance has to pay for them too. So the consultant is the gatekeeper for MRI

[Sheepshanks]

The_Doc said:

(Some) GPs over order MRIs and the insurance has to pay for them too.

Don't follow that - the insurance doesn't have to pay for anything. You have to get it authorised first, and in my case they wouldn't authorise an MRI based on the GP's say-so.

[The_Doc]

Sheepshanks said:

Don't follow that - the insurance doesn't have to pay for anything. You have to get it authorised first, and in my case they wouldn't authorise an MRI based on the GP's say-so.

The insurance company wants to pay for the fewest scans.
The popularity of scan requesting is Patient>GP>Consultant
Therefore the request has to come from the consultant

Patients and GPs, with the greatest respect to both groups, would waste the resource.
Its quite similar in the NHS

[King Herald]

DJFish said:

I'd imagine self diagnosis/referral isn't the most reliable method.

So, I tell my doctor I need a referral for a carpal tunnel operation, he writes me a letter, then I go to the specialist, who makes me undertakes a while series of tests to determine if I am telling the truth. He didn't just cut me open and take my money.

Problem was. I didn't have it at the scheduled time of the tests, as it only appears if I do heavy work for a short period, and lasts a miserable, sleepless week then slowly fades away again as inflamation goes down.

They did a whole battery of examinations, as well as electric nerve testing, to the tune of £1200

Turns out I was right, I DO have it....... apparently they can measure that my hands were actually dying off slowly, nerves failing, sensitivity disappearing every time I had a bout.