Here are a selection of questions that we have collected.  If you have a question not here, please send it in and  we’ll add it here.

    • I am switching my insurance company. Why is the new insurer asking for my medical history?

Some insurers will ask for your previous medical history. Any pre-existing conditions may be excluded by a new insurer so it is important that you disclose your medical history to be clear what your insurer will cover. If you make a claim shortly after taking out the policy, your insurer will check with your GP as part of the claims process. Under some corporate policies, subscribers are accepted without any such exclusions. You should ask your insurer or broker carefully about these matters before switching.

    • My GP has provided me with a referral for treatment but I want to know how to choose a suitable consultant?

Your GP should know or be able to recommend a suitable consultant. If this is not possible, then depending on your condition, you may wish to contact your local private hospital for help. Alternatively, you may look under the specialty area on the websites within the hospitals or elsewhere. For example, if you have a skin problem, you may wish to look up dermatologists and decide from there if the consultant is appropriate.

    • Can I ask for an estimate of the consultant’s fees before seeing him?

You are entitled to ask for the consultant’s fee estimate before confirming an appointment. Mostly, this will be for an initial consultation charge. Of course, there may be added charges if you have various procedures done. If you are booked in for a procedure or operation, ask for an estimate of fees from your surgeon or consultant. Do check that everything including any anaesthesia is included. In an emergency situation this is not always possible. Of course your consultant may not always be able to predict exactly what will happen when you are admitted to hospital and whether or not you might need the services of other specialists. Don’t forget to seek pre-authorisation from your insurer when you will also be able to check what is included and what you might have to pay for yourself

    • I have arranged a self-pay package price for my operation at a private hospital – what happens if I develop complications?

You should enquire carefully with the hospital and/or the consultant to find out exactly what your package price includes. Complications are a difficult issue. They are sometimes included into the package price. The risks involved with your procedure will often determine the likelihood of complications. Do ask at the hospital for detailed information about costs in advance of any procedure – you will not find any resistance to your questions.

    • My insurer has told me that my diabetes is not covered under their policy. Why is this?

Private Medical Insurance is usually only for acute illness. Many illnesses by their very nature become chronic,. Examples are diabetes, heart failure and asthma. Insurers may not then cover you for consultation fees or treatments for such conditions. However, should you develop a separate complication as a consequence of this underlying illness and the complication is an acute, new condition then you ought to be covered. You need to enquire carefully through your specialist and the insurer.

    • My private medical insurance is provided through my company. I am retiring and wish to take this on personally – will the same terms and conditions apply?

Some companies will maintain their retired employees on the scheme, in other instances the individuals may take over personal responsibility for their premiums in which case the terms and conditions may alter. You should inquire carefully through your company and/or broker as well as approaching your private medical insurer about this matter.

    • My insurance broker says that if I pay for all my out patient consultations he can lower my annual insurance premium. Should I do this?

Known as an excess or co-payment, this type of plan is often attractive to both insurance company and subscriber. Any insured person or group that takes on a degree of co-payment will lower their annual premiums. You should discuss this carefully with your broker and work out the best formula. Some co-payments are capped at a fixed total for the year and this may range to any level. Others have a fixed percentage component for each separate episode of care that you may have in a year.

    • My consultant was rather dismissive and brisk when he saw me and I was not satisfied with his explanation of my condition. What should I do?

In the first instance, it is best to discuss these matters in frankly manner with the specialist concerned. You can also discuss this matter with your GP and possibly write to the consultant for a fuller explanation. If you are still dissatisfied then of course you may have to seek an alternative opinion. If you feel this is not satisfactory then you should look at other methods of complaining about your consultant and follow the procedures in our complaints section.

    • My insurer has changed some of the conditions of my policy. To whom can I complain?

If you are a personal subscriber then you should write to your insurer laying out your specific complaints. If their answer is not satisfactory then you have the option of taking this further but much will depend on the nature of the change and whether or not this is unfair. If you are in a corporate policy then it would be best to tackle this matter through the person in your company responsible for your insurance scheme, laying out the change of conditions which you perceive as being unfair. You can also look at out methods of making a complaint against your insurer here.

    • My recent outpatient consultations and investigations have not been fully covered by my insurer. Is this normal?

Your insurers lays down a list of reimbursements or benefits that they will pay you for consultant fees. In some cases, there is no official benefit laid down and the insurer will pay what they take to be usual and customary. Consultants are not bound to adhere to these reimbursement rates and they set their own fees. It is helpful to have advance notice of these if possible and, as indicated elsewhere in these FAQs, you may try to obtain an estimate prior to the consultation.

    • I was recently treated at a hospital which I thought seemed rather dirty. I am worried I might have contracted MRSA. What should I do?

It is most unlikely, if you are well that you have contracted anything of significance at the hospital. However, MRSA is now widespread in the community which means that many people will carry this bacteria in their nose or on their body. This has no particular significance unless you are going for complex surgery or have other specific illnesses. MRSA is dangerous if it gets into the blood stream or becomes an overwhelming infection. If you are concerned you should consult with your GP or return to the hospital where suitable swabs may be taken of your nose, armpit and groin to see if you are in fact a carrier. Of course, if you are ill in any way then you should consult with your general practitioner immediately.

    • I wish to know how clean the hospital is where I am about to undergo surgery. How do I get this information?

Most private hospitals have a very low rate of infection with MRSA or C.Dificil or other serious bacteria. Most of the independent hospitals will publish their general rates of MRSA and other infections on their websites or in booklets and you can certainly inquire about this either through your specialist or the hospital prior to going in for treatment.

    • When I undergo surgery will I be able to choose the anaesthetist?

You can discuss the choice of anaesthetist with your surgeon.  Anaesthetists often have sub-specialist interests (e.g. children’s surgery, ENT surgery, eye surgery, heart surgery and so on). Surgeons and anaesthetists usually work in teams which is best practice. We recommend that you are guided by your surgeon in choosing the anaesthetist for your procedure.

    • How can I find out about the specialist interests of the consultant I have been referred to?

Most consultants can be found by an internet search. Some have their own websites and some will be listed in the Private hosiptal where they work. If you have difficulty in obtaining this information then you can contact the consultant or private hospital who should be able to give you further details. You should also consult your GP if you have any questions.

    • I am unhappy that my insurer has directed me to a hospital a longish way from where I live. To whom can I complain?

Some private medical insurers have network agreements with different hospital. This means that they may preclude you from going to a hospital in your locality. Many insurers do allow full reimbursement for treatment outside the network where the network hospital does not have the equipment or expertise to carry out the recommended procedure. However if this is not the case then you should first complain to your insurer and ask if they will pay for you to go to a hospital of your consultants choice, or one which is more geographically convenient. If they persist in sending you to an alternative hospital, you may have no option but to accept. You may complain to the financial ombudsman service where some rulings have been made in favour of a patient in this type of situation but usually patients will have accepted these network arrangements when they sign into their specific private medical insurance policies.

    • My GP has referred me to a consultant but my insurance company will not give me authorisation to see him as they say they do not recognise him. I will insist on being treated by him but to whom can I complain about this as I am now out of pocket?

If your consultant is an appropriately trained consultant with specialist qualifications then he should be recognised by the insurance company. Unfortunately, for a number of different reasons which do not necessarily reflect your consultant’s abilities, certain consultants have been ‘delisted’ – that means taken off the list of consultants to be used by the insurers. If you have been treated by a consultant who has been delisted and your insurer refuses to pay, you should follow the complaints procedure of your insurance company. If after their ‘final decision’ letter you are still unhappy refer the case to the financial ombudsman service as recommended in our complaints section. There have been several instances in which the ombudsman has forced the insurance company to reimburse the patient to the level they would have received had they gone to a recognised consultant.

    • When will I have a ‘shortfall’ (that is have to pay part of the costs from my own pocket)?

A shortfall from your insurance company may arise for several reasons. Your policy may exclude certain conditions. You may have to meet certain co-payment for outpatient treatment or specific x-rays. This should be clearly stated in your initial policy agreement. Another reason for a shortfall is that certain aspects of your care within a hospital may not be covered. Finally, there may be shortfalls on your consultant fees because the benefits paid by the insurance company do not cover the fees in their entirety. It is wise to obtain an estimate before you start treatment although this is not always possible. Ultimately, you are responsible for your consultant and hospital fees – the insurance company reimburses you at the rate laid down in your policy.

    • My insurance company has said that my consultant charges too much and that I should see someone else, what do I do?

You should always insist on seeing your chosen consultant.  That is because you are so advised  by your GP or by other recommendation – that is usually why you chose private medicine! This is especially important if you have been treated by this consultant in the past and are satisfied with his or her management of your case. This continuity of care is vital. You should insist with your insurance company at pre-authorisation that you are sent to the consultant of your choice. Some insurers might try to enforce extra financial penalties by reducing the benefits you receive for seeing this consultant and you should always insist on having the full benefits and payments that you would get if you had seen an alternative consultant.

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