Private health insurance
Private health insurance
Author
Discussion

Jayessgee

Original Poster:

199 posts

157 months

Wednesday 12th February 2014
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Looking to get private health insurance for me and my good lady. Seems to be a myriad of companies out there. Anyone got any recommendations or things to look out for when buying such insurance?

Sarnie

8,373 posts

239 months

Wednesday 12th February 2014
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What exactly are you wanting to be covered for? Just to make sure the cover you are wanting is actually PHI....

161BMW

1,874 posts

195 months

Wednesday 12th February 2014
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Am also looking for one
Which is best one if I want to put in a claim in 2 months time :-) ?

Big E 118

2,468 posts

199 months

Thursday 13th February 2014
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Like most things really, in general the more you pay the more you get. Also really depends on if your looking at contributions to chronic or pre-existing conditions. As per car insurance look at excess's and exclusions.

A lot of people are unhappy with Bupa at the moment as they are becoming very restrictive on the specialists you can see. The general opinion is that they are referring patients to the cheapest consultants, not the best for your condition.

Cigna and WPA seem to be the "premium" brands and tend to have a more generous fee structure.

The key is, if you need to see a specialist find out how much they charge, what the hospital fees may be and make sure your insurer will cover this in full (barring excess's) before seeing the consultant.

The Leaper

5,721 posts

236 months

Thursday 13th February 2014
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By coincidence I've just got back from taking the wife to hospital (private) for her third hip operation in five years, so I reckon we have a fair experience with private medical cover PMC (not to be confused with private health insurance PHI).

There are an infinite number of types of PMC contracts available, ranging from cash payment plans where the treatment is in the NHS and the patient gets a cash sum per day of hospitalisation, through to 100% cover for PMC. The costs are very different, of course. So, decide what you want and more than anything check the FULL contract conditions before you sign up. Look especially at what is and what is not covered, and what the excess is and when it applies, probably separate excesses for different treatments.

Wife and I have a BUPA contract. In the past we paid 50% of all out patient costs and were covered 100% for in-hospital treatment. For today's op, there is an outpatient excess of £75 which is better from our point of view. Bear in mind that any hospital treatment will have both in and out patient costs, for example all the pre op checks and any physiotherapy afterwards will all be as an out patient.

I agree that BUPA, among others, have disallowed cover for some hospitals due the high fees charged by surgeons, anaesthetists, etc but this could be considered a good thing as it will help to bring down excessive fees.

The Leaper

5,721 posts

236 months

Thursday 13th February 2014
quotequote all
By coincidence I've just got back from taking the wife to hospital (private) for her third hip operation in five years, so I reckon we have a fair experience with private medical cover, PMC (not to be confused with private health insurance PHI).

There are an infinite number of types of PMC contracts available, ranging from cash payment plans where the treatment is in the NHS not as a private patient when the patient gets a cash sum per day of hospitalisation, through to 100% cover for private medical treatment via PMC. The costs are very different, of course. So, decide what you want and more than anything check the FULL contract conditions before you sign up. Look especially at what is and what is not covered, and what the excess is and when it applies, probably separate excesses for different treatments. And the cheapest is almost certainly not worth having because the cover will be so restrictive: don't buy on price but on protection.

Wife and I have a BUPA contract. In the past she has paid 50% of all out patient costs and she was covered 100% for in-hospital treatment and accommodation. For all activities for before and for today's op, there is an out patient excess of £75 which is better from our point of view. Bear in mind that any hospital treatment will have both in and out patient costs, for example all the pre op checks and any physiotherapy afterwards will all be as an out patient.

I agree with what's said above that BUPA, among others, have disallowed cover for some hospitals due the high fees charged by surgeons, anaesthetists, etc but this could be considered a good thing as it will help to bring down excessive fees. In any case, I do know that if BUPA do raise this issue you can always arrange with BUPA that they settle the fees as per their maximum and then you pay any excess fees.

If the OP is expecting hospital treatment in two months time I suspect getting PMC will be really difficult for that specific treatment because of possible pre existing conditions exclusions.

R.

Elderly

3,738 posts

268 months

Thursday 13th February 2014
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Big E 118 said:
A lot of people are unhappy with Bupa at the moment as they are becoming very restrictive on the specialists you can see. The general opinion is that they are referring patients to the cheapest consultants, not the best for your condition.
Can they do that (I'm not with BUPA)?
The reason I have cover is so that I can choose the best person for the job.



The Leaper

5,721 posts

236 months

Thursday 13th February 2014
quotequote all
Yes they can, and do. It happens because, depending on your particular BUPA contract, there will be a set table of maximum individual fees for all the people involved eg £x for the surgeon, £y for the assistants, £z for the anaesthetist etc, which therefore excludes any medical person whose fees exceed the BUPA maximum. So, at the outset you decide which particular private hospital you want to go to for the treatment and then BUPA will tell you who they will and not pay for at that hospital.

This has recently happened for my wife: the anaesthetist she had last time now charges over the BUPA maximum in our contract so they said they would only pay for Mr. X who is on or below their maximum, unless my wife paid the excess for the other anaesthetist.

R.

Big E 118

2,468 posts

199 months

Thursday 13th February 2014
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Elderly said:
an they do that (I'm not with BUPA)?
The reason I have cover is so that I can choose the best person for the job.
A good explanation from The Leaper explains how it works.

Whether they can do it is one part of this investigation by the competition commission http://www.competition-commission.org.uk/our-work/...

There have been provisional findings published which have completely ignored the main points of he investigation though.



LotusMartin

1,127 posts

182 months

Thursday 13th February 2014
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Elderly said:
an they do that (I'm not with BUPA)?
The reason I have cover is so that I can choose the best person for the job.
Unfortunately they are moving the goal posts

For example, my wife can no longer claim 'quality of life changing' treatment from a cranial osteopath she has been using for many years - having talked to the guy a few times, the whole profession has just about had it with Bupa.

On the other hand, Pru Health are more than happy to use them.

Elderly

3,738 posts

268 months

Thursday 13th February 2014
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I HATE insurance and for all things except what I call 'catastrophe' insurance,
I've mainly self insured over the years.

But the one insurance I'm happy to waste money on is medical insurance.
I've never been with BUPA because friends in the medical profession who see claims from the other end have always advised me against them.

Jayessgee

Original Poster:

199 posts

157 months

Thursday 13th February 2014
quotequote all
Sarnie said:
What exactly are you wanting to be covered for? Just to make sure the cover you are wanting is actually PHI....
Maybe I have my terms confused! I'm after cover that will give us private treatment if we need an operation or something like that. Scans etc.... Just so we don't have to wait ages on nhs and can get better after care etc.

HereBeMonsters

14,180 posts

212 months

Thursday 13th February 2014
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I would (biasedly) recommend SimplyHealth. biggrin

J012E

93 posts

161 months

Friday 14th February 2014
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Hi guys, whether it be PMI or PMC, I can offer whole of market advice. I can tailor the level of care you would like vs premiums also. PM me if you are interested.

Revisitph

983 posts

217 months

Sunday 16th February 2014
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The Leaper said:
I agree that BUPA, among others, have disallowed cover for some hospitals due the high fees charged by surgeons, anaesthetists, etc but this could be considered a good thing as it will help to bring down excessive fees.
Many established consultants will not sign up to BUPA's "recognised" [fee scale] status. They maintain that BUPA has tried to use its shrinking but dominant market position (with about 40% of PHI) to squeeze down fees and that for many procedures they've tried to freeze or reduce rates, in some cases for decades while the cost of being in practice, especially insurance has soared. These consultants have thriving private practices and are kept busy by patients who believe it worth paying that consultant's fee. New consultants may not feel able to decline to agree to BUPA's low fee scales until they have built up their practice.

BUPA, like any big business will try to squeeze its suppliers to cut costs, even if they might ultimately put small suppliers out of business (or, in the case of consultants, the small suppliers decide that they don't want to sell their wares at an uneconomic price). However consultants, like plumbers or builders will need to take lower priced jobs when they are starting out or when work is scarce, but once they have built up a client base, can decide whether they do unprofitable jobs or not.