If you are currently waiting for treatment or having your condition tested, you may be wondering if private health insurance is the solution. In this guide, we explain why health insurance doesn’t cover pre-existing conditions and offer other options to consider.
The challenge of waiting for treatment in the UK
If you’re currently waiting for medical treatment in the UK, or perhaps in the early stages of having tests and tests, you’ll know that NHS waiting times are currently some of the longest, with a record backlog of both non-urgent and urgent treatments ahead of you in the queue.
When doctors’ strikes are added to this, with the three-day work stoppage in June, which will have a “huge effect”, according to prof. For Stephen Powis, National Medical Director of NHS England, it’s completely understandable that you’re worried, potentially in pain and looking for solutions.
Unfortunately, insurance cannot provide the solution you are hoping for if you were undergoing treatment or illness before you took out the health policy.
In this article, we explain why that is and discuss some other avenues you might consider to get the care you need.
Why health insurance does not cover pre-existing conditions
This section explains what a pre-existing condition is and why most health insurance policies don’t cover it.
Definition of pre-existing conditions
Pre-existing conditions are any illnesses or injuries you had before the health insurance policy started. These range from chronic conditions such as diabetes to recent injuries or ongoing treatment.
An insurance perspective: risk management
From an insurance point of view, covering pre-existing conditions is a high risk. Because these are known issues, you are very likely to make a claim, which is a costly risk for insurers. Therefore, almost all policies exclude them in order to make the premiums affordable to a wider range of people. The only exception is large corporate policies that opt for a type of coverage called “Medical History Neglected”; however, it must be said that this comes at a high price.
Your Health Insurance Policy: Reading the Fine Print
Here we explain more about what is and isn’t covered by a health insurance policy. Note that this is all general information and you should refer to the policy documentation for exact details.
What most health insurance policies cover
Health insurance usually covers the treatment of acute conditions that develop after the policy is taken out. This may include surgery, therapy, and sometimes even specialist consultation, but usually not treatment of chronic conditions.
When pre-existing conditions become eligible for coverage
Now, there are cases where pre-existing conditions might be covered. Some policies have moratorium periods. After a certain period without symptoms or treatment for a pre-existing condition, usually around two years, the insurer power cover the balance. However, this varies from policy to policy and the coverage is decided at the outset.
Bypassing the waiting list: alternative solutions
We know many of you will still be looking for options and we want to offer some solutions that may help, although they all require funds to pay for treatment.
1. Self-payment of consultations and treatments
If you are waiting for treatment, one option is to fund some aspects of your care yourself. This may include consultation, diagnosis or even treatment. Yes, it can be expensive, but it can help you cut down on your wait time.
2. Privately paid services with a return to NHS treatment
Another approach to consider is the mix-and-match method, which combines private and NHS care. For example, you may choose to pay for an initial consultation or diagnostic test privately and then return to the NHS for the actual treatment. This approach could speed up the diagnosis process without the full cost of private treatment.
How to get offers for treatments
If you want to find out how much a particular test or treatment might cost privately, you’ll need to contact a private hospital for a quote or contact a consultant directly to find out their costs.
Links to private hospital groups in the UK:
Note that there are also a number of independent private hospitals, which may be closer to where you live.
Find a private medical advisor.
There are several ways to find a private medical adviser, but a good place to start is the PHIN website.
The importance of understanding your insurance policy
We cannot stress enough how important it is to thoroughly understand the ins and outs of your insurance policy. Knowing what is and isn’t covered can help you make informed decisions about your health care options.
Strategizing your healthcare: Combining private and NHS services
Remember, combining NHS and private health services could be a strategic way to manage costs while reducing waiting times. It’s about finding the best balance for your specific needs and circumstances.
