There is more than one way to access private healthcare in the UK. You can use private health insurance if you have it or choose self-pay. In some circumstances, you can even combine the two. Here’s our guide to self-pay treatment versus health insurance so you can consider your options.
How does private health insurance work?
Private health insurance gives you access to private health care and your health insurance pays the costs. When you take out a health insurance policy, you’ll get basic cover as standard, and you can add extras to make your cover more comprehensive. You can opt for individual health insurance or add your partner or children to provide private health insurance for the whole family.
You pay an annual or monthly premium and contact your insurance provider to make a claim when you need access to private healthcare.
Find health insurance: Read our guide to the best health insurance providers in the UK.
What does health insurance cover as standard?
Health insurance policies vary among providers, but most are covered by private health insurance day patient and hospital treatmentcancer care and some form of mental health support. So if you need to be admitted to hospital for surgery, your health insurance policy will pay for it.
You’ll also have access to private support services, such as a virtual or digital GP offering 24/7 appointments, helplines and online resources providing health advice.
What are some of the extras?
You can customize your private health insurance policy to include a wider range of treatments and services. Outpatient insurance offers many of the main benefits of private health insurance, including consultations, diagnostic tests and outpatient treatments such as physiotherapy. Other optional extras include cover for therapy and additional mental health treatment.
If you want to improve your basic coverage, you can also add additional treatments or increase the financial limits for different types of treatments.
What is not covered?
Every health insurance policy has exclusions, which means you won’t have access to private healthcare for certain conditions. These typically include addiction treatments, cosmetic surgery, and normal pregnancy and birth. Private hospitals also do not offer emergency treatment, so they are not an alternative to an ambulance if you have a life-threatening condition. There are other circumstances where your private health insurance will not pay for the cost of your care.
Chronic conditions
Chronic conditions are diseases that your doctors cannot cure with a single course of treatment and require long-term treatment and monitoring. Chronic diseases include conditions such as high blood pressure, diabetes and angina.
Private healthcare only treats short-term acute conditions, so you’ll need to stick to the NHS if you have a chronic illness.
Pre-existing medical conditions
Private health insurance does not cover pre-existing conditions. These are all conditions for which you sought medical advice or treatment during the five years before you took out private health insurance. Depending on the type of cover you have with your policy, your insurers may ask you to provide details of your health history when you sign up for private health insurance. Alternatively, your insurers can investigate to ensure that the treatment you need is covered when you make a claim.
Pre-existing medical conditions are excluded for the first two years of your policy and can be added after that if you remain symptom-free. For example, if you had physiotherapy for knee pain before you had private health insurance, you will not be covered for knee surgery in the first two years of the policy.
Read our guide on why health insurance doesn’t cover pre-existing medical conditions.
How does self-pay care work?
Self-pay options allow you to pay for your treatment without paying for private health insurance. You can choose a private hospital and a specific consultant specializing in the treatment you need and pay the treatment costs directly. There are different ways to approach self-financed treatment. You may want to pay for the initial consultation and diagnostic tests or the full cost of the surgery.
How to work with a private healthcare provider
Choosing to finance your own private healthcare allows you to research to find a private hospital that suits your needs. Most private healthcare providers have details of their self-pay process on their websites. You will often be able to contact them online or by phone to ask questions or book an appointment. Some ask for a GP referral to make sure the consultant you want to see has the right expertise to treat you. You may also be able to book a private appointment with your GP online to speed up the process.
Your chosen provider will then give you a quote for the treatment you need. You will usually have to pay immediately for the initial consultation. Most providers also offer flexible payment plans to allow you to spread the cost of your treatment.
What is included in self-pay costs?
The offer you receive from your doctor will detail all the elements involved in your treatment. The surgery offer will likely include your initial consultation (unless you have paid for it separately), pre-operative examinations and some post-operative rehabilitation. It will also include the cost of private surgery, for example, your surgeon, anesthesiologist and medical staff, and private rooms while you are in hospital.
When could I choose a self-pay treatment?
Self-pay offers an alternative to private health insurance and NHS treatment. If you want to access healthcare quickly and face long waits for NHS treatment, self-pay can offer an excellent alternative if you have the funds available. Here are a few top reasons why self-pay might be the right choice for you.
Your treatment is cheap
The price of private surgery depends on what you need. Some procedures, such as cataract surgery, tonsillectomy or colonoscopy, cost approx £1,500 to £2,775. Others cost much more, with knee surgery or hip replacements costing between £12,000 and £13,000. However, if you have the means, you may consider it worth the cost if it helps restore your quality of life.
Your views on what constitutes cheap treatment will depend on your circumstances and how much you have saved up.
You want a quick diagnosis
If you want to see a consultant quickly or have a diagnostic scan and tests done privately, this will usually cost several hundred pounds. The cost could be worth it if it helps you spend less time on an NHS waiting list.
Even if you can’t stretch to private treatment, it could help you get the care you need faster.
You do not already have health insurance
If you have seen a GP and received a referral to a consultant, private health insurance will not cover your treatment as your insurance company will class it as a pre-existing condition. This means you will have to wait for NHS treatment or fund your own private healthcare.
Your health insurance does not cover your treatment
You may already have private health insurance but have found that it does not cover your treatment, either because you do not have the right level of cover or because of an exclusion on your policy. For example, you may have chosen private health insurance to cover inpatient treatment and surgery, or private treatment if you were diagnosed with cancer, but found that outpatient coverage costs your health insurance beyond your budget.
If you don’t have outpatient insurance, you won’t be able to get a private diagnosis, but you can get a referral from your GP for private healthcare after being diagnosed on the NHS.
Are there circumstances when self-pay is not a good idea?
Sometimes paying for private health care costs yourself is not a viable option because you don’t have the funds available. Payment plans and medical loans can help, but you’ll need to meet the borrower’s criteria or be sure you can meet the monthly costs of the payment plan.
While most private hospitals offer fixed-price packages for surgeries, other types of medical treatment are less predictable. If you don’t already have private health insurance, cancer treatment could cost hundreds of thousands of pounds, depending on your needs.
Can I choose where I will be treated and which consultant I will see?
Paying for private medical care gives you complete control over which consultant treats you and which hospital you go to. This allows you to choose your consultant and hospital based on criteria you specify, for example the consultant’s experience and expertise, treatment close to home or hospital facilities and services.
How much does private treatment cost?
Private treatment costs vary depending on many factors. The price depends on the type of treatment you need and the healthcare provider and hospital you choose.
Location can be a significant factor, affecting everything from staff salaries to rent and utility bills. Some providers have relationships with NHS hospitals or offer their own hospitals with hotel-style facilities. If you have already seen an NHS consultant, you may be able to have private treatment with him in a private room in the same hospital.
How much does health insurance cost?
The cost of private health insurance is based on various factors that health insurers use to assess the risk you will claim under the policy. This includes your personal circumstances, for example, where you live, how old you are and the type of work you do. The older you are, the more your insurance will cost. Equally, if you work in construction, there is a much higher risk of an accident than if you sit at a desk all day.
