You may be wondering if health insurance could be a scam that takes your money and find reasons to deny your claim. Is it worth the cost? This guide examines why health insurance may not be right for you so you can make an informed choice.
How does private health insurance work?
When you invest in private health insurance, you can choose from a variety of insurers on the market. Each insurance company offers different levels of coverage, and you can tailor your policy to suit your needs.
For example, you can opt for a basic plan that covers hospital treatment, such as surgeries and cancer treatment. You can also add optional extras, such as outpatient treatment that covers diagnostic tests, scans and other therapies, such as outpatient physiotherapy.
Once you are satisfied that the policy meets your needs and budget, you start paying your monthly or annual premiums and your coverage starts immediately.
Reasons why you think health insurance is a scam
If you suspect that your health insurance may be a scam, you probably have your reasons. You may think that private health services are undermining the NHS and want to avoid becoming part of a two-tier system. Maybe you’ve always had excellent NHS treatment and don’t see the point of paying when you can get the healthcare you need for free.
There are good reasons to invest in private health insurance, but there are also circumstances in which private health care is not the right choice. Understanding how health insurance works and the options available can help you make a decision.
1. The cost of premiums is too high
You may have looked at the cost of private health insurance and thought it was too expensive, especially when you can get free treatment through the NHS. We all have to work within our budget and prioritize spending properly. When you look at the average monthly costs, health insurance may seem out of your reach.
However, it’s worth remembering that you can tailor your coverage to suit your needs. You can opt for a basic policy without any extras. There are other ways to reduce the cost of your policy, such as adding an excess or allowing your insurance company to recommend a consultant rather than being completely free to choose.
A broker can help you find deals that fit your budget.
2. I will pay for years without needing treatment
There is a risk that you will start paying for health insurance and never need to use it because you will stay healthy. No one can predict the future; you can pay premiums for many years and then make several claims as you develop health problems over the years.
Self-insurance can offer an alternative if this is something you are concerned about. Instead of sending premiums to the insurance company, open a savings account and pay into it regularly, just as you would if you took out an insurance policy. Then, if you want private health care, you can use the money you’ve saved to pay for it. This can be a great option if you need surgery, as most private healthcare providers will offer you a fixed price. It’s less practical if you need cancer treatment, as it can take forever and cost hundreds of thousands of pounds.
Self-insurance also means you can use your money in other emergencies; although you might save to pay for private treatment, you have more choices about how you spend it.
3. My health insurance will deny my claim
Denied claims often stem from a misunderstanding about what coverage your health insurance provides. When you buy a policy, your insurance company will send you information to confirm what treatment the plan will pay for. There will also be policy exclusions detailing the types of treatment your insurance will not cover. This includes things like cosmetic surgery, addiction treatment, and normal pregnancy and birth. They also rule out pre-existing conditions.
What are the previous conditions?
A pre-existing condition is an illness you had before you had health insurance. It can include anything you’ve been treated for or sought advice from your doctor in the five years before you bought the insurance. For example, you may have seen your GP because of shoulder pain. You buy health insurance a year later, and a year after that your doctor recommends a shoulder replacement. Your insurance won’t pay for private surgery because you’ve had shoulder pain before.
If you choose full medical cover, you can provide your insurance company with details of your medical history at the start of your policy so you know from the start what is covered or excluded.
4. I can’t use my health insurance for things I really need
Medical insurance is great for conditions that your doctors can treat through treatment, allowing you to get on with your life. It won’t be for you if you have a chronic condition, such as asthma or diabetes, that requires regular monitoring and treatment, as these types of conditions are excluded from cover.
Unfortunately, it probably won’t be right for you if you already have a lot of health problems. For example, if you’ve had back problems and want insurance so you can get private treatment if it gets worse, your insurance may not cover you. You will need to be symptom free for five years before you buy the policy or two years after that if you want it to be covered.
A self-insured or self-pay approach may be better because it allows you to pay for care that your health insurance won’t cover.
5. Will the customer service be good?
One of the main advantages of health insurance is that it gives you quick access to private treatment. However, this only applies if the requests can be approved immediately. Most insurance companies are large companies that employ a lot of staff. It’s inevitable that some people’s customer service experience is better than others. If your claim is complex, it may take longer to make a decision, and the insurance you have on your policy may also have an impact.
Many insurers require you to initiate a claim online or through an app. While it is quick and convenient for some, it can be challenging for others. Some insurers prefer that you call to make a claim. However, this may leave you waiting on the phone to get through to a busy call center.
Reading third-party reviews online allows you to see what other users are saying about the service. You can read our summary of the top eight UK health insurers here. Most insurers also share links on their websites to third-party review sites, such as Feefo or Trustpilot.
6. Private healthcare companies are only interested in profit, not patient care
Whether you choose NHS or private treatment, your doctors will be highly trained and experienced and will offer the same standard of care.
Some private health services are profitable businesses with shareholders to keep happy. However, others invest their profits back into patient care and better facilities. Private hospitals may have facilities and catering closer to a luxury hotel than a hospital. They are also free to invest in new equipment and treatments that are not currently approved by the NHS. This could mean that you benefit from cutting-edge technologies that can produce better results and faster recovery.
The picture is a little different if you need emergency treatment. Insurers provide virtual GP services and 24/7 medical advice hotlines. However, they cannot treat you in a medical emergency. If you have a stroke, heart attack or even severe complications after private surgery, you will need the NHS.
What are the alternatives if health insurance does not suit me?
Health insurance isn’t the right choice for everyone, so if you’ve turned it off for whatever reason, you can still get private treatment if you want to. Alternatively, you might prefer to stick with the NHS.
NHS treatment
NHS care is provided by experienced staff who are experts in their field. It is also free to use. The downside is that you can wait a long time for treatment unless your condition is life-threatening.
However, you can usually choose which consultant you want to see and where you want your treatment to take place.
Self-financed private treatment
If you have savings, you can use them to self-finance your private healthcare. You can contact your healthcare provider directly and get a fixed price quote for surgery or other therapies. This option gives you a completely free choice of the hospital you go to and the consultant you want.
If you have seen an NHS consultant, you may also be able to pay privately to get treatment faster. Consultants offer private consultations and surgeries.
Getting professional advice
myTribe guides help you understand your health care options so you can make an informed choice.
If you would like more information about private health insurance before deciding whether it is for you, contact us for a comparative quote. We will put you in touch with a specialist, regulated broker who will give you advice tailored to your circumstances.
