What it means for you

Some insurers have networks of preferred providers – specialists and hospitals that an insurer may recommend you to as an alternative to the specialist your GP may want you to see.

Typically, an insurer may link up with a particular hospital group and then direct its customers to specific consultants practising at one of the group’s hospitals rather than to a consultant and hospital chosen by your GP.

So what are the advantages and disadvantages of preferred provider networks?  By choosing to send more customers to particular hospitals, an insurer may be able to negotiate lower prices from the owners of the group and from their ‘preferred’ consultants. Obvious cost reductions can be achieved which should be reflected in the premiums.  The downside is that the insurer can make decisions about where you are treated and by whom, based on financial considerations and not based on your particular clinical need.

Medicine is becoming more and more specialised.  On a preferred provider network you could, for example if you need an operation on your knee, be sent by your insurer to a qualified general orthopaedic surgeon at a preferred hospital rather than to a highly specialised expert in knee surgery.  Have this in mind when you choose your insurer.

There have even been cases of patients being told their GP or consultant wants them to have ‘the wrong treatment’ and suggestions that they should see a different consultant. If this happens, patients should always contact their GP right away and their chosen consultant to discuss the alternatives.

Our advice is straightforward: if you are attracted to a policy that provides you with cheaper premiums, it is always best to examine the fine detail of that policy before you sign up.


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