NHS waiting lists: Is it worth paying to jump the queue?
MoS private health care special: Should you shell out to beat the NHS waiting list crisis… although the answer might surprise you
Three-quarters of a million struggling with agonising hip or knee pain in desperate need of a joint replacement operation, 600,000 awaiting treatment for cataracts, some people waiting up to five years for surgery…
With these colossal logjams and delays it will come as no surprise that many have given up hope of getting help on the NHS – and have paid for private treatment instead.
The pandemic sparked a mass exodus from the health service, with two million Britons biting the bullet and turning to savings, taking out loans or cashing in on health insurance plans to finance a vital procedure.
The NHS waiting list crisis has 750,000 people struggling with damaged knees or hips, while a further 600,000 are waiting for surgery on their cataracts
The surprising truth is, private healthcare might not be as out of reach as you think. But if you are considering taking the plunge, it can be difficult to know where to start
People spent £126 million on hip replacements, knee replacements and cataract surgery between July and September last year, according to the most recent data.
So should you join them?
The surprising truth is, private healthcare might not be as out of reach as you think. But if you are considering taking the plunge, it can be difficult to know where to start.
With this in mind, we spoke to the UK’s top private healthcare experts – and over the following pages, you’ll find vital details about how to find a private doctor, what you can expect to pay for common procedures, and how to ‘mix and match’ private and NHS treatment.
Read on, and arm yourself with everything you need to know to get the best care, at the best price…
Reasons why many decide to go private
You’ve been told you need surgery – but it could be months, or more, before your doctor will even give you a date for your op.
This is, by far, the main reason people choose to go private, according to health insurance broker Brian Walters.
‘People pay because they want timely treatment,’ he says.
‘Other concerns include comfort – if you want a room to yourself after an operation, rather than being put on a busy ward, then you’ll have to go private.’
David Hare, CEO of the Independent Healthcare Providers Network, says: ‘The things people go private for – things like hip ops for arthritis and cataract surgery – aren’t problems that will kill you, but they massively affect quality of life.
‘So people are saying, life is short, this is causing me trouble, can I get it sorted quicker if I pay for it?’
You’ve been told you need surgery – but it could be months, or more, before your doctor will even give you a date for your op
Experts say paying doesn’t necessarily mean better care.
In fact, most of the best private consultants also practise on the NHS, offering many of the same procedures.
But there are treatments that are only available privately.
Some operations, for example for enlarged prostate, bunions or varicose veins, aren’t offered on the NHS.
This is usually because the procedures are very new, so haven’t yet been approved. It could also be because the condition doesn’t impact the health of the patient enough to warrant an operation, under NHS guidelines, or because a procedure is considered cosmetic.
And cosmetic doesn’t just mean things such as boob jobs – varicose veins in the legs, for instance, can be unsightly and even cause discomfort, but the op to remove them is rarely offered on the NHS unless they are severe, and linked to ulcers, bleeding and pain.
Urological surgeon Marc Lucky says: ‘It takes time for a procedure to be evaluated and prove its cost-effectiveness before it gets NHS approval – so if you want the newest thing, you might have to pay.’
You don’t need health insurance…
Around eight million people in the UK hold some kind of private health insurance, which pays out for treatment or surgery when it is needed.
But insurers won’t cover existing problems in a new policy, so if you’ve already got a diagnosis, and are hoping to reduce the wait for surgery, the only option is to pay for it yourself.
The number of people doing this is surging. Last year, Spire, one of the UK’s leading healthcare providers, saw a 47 per cent rise in patients paying for surgery out of their own pockets, while HCA Healthcare said its self-paid surgery has doubled since the start of the pandemic.
Many clinics now offer self-pay packages, which include tests, the operation, aftercare, anaesthetic and hospital care, for a fixed price
This is partly because it’s become far easier to get care – until recently, only a handful of hospitals actually permitted self-paying patients, but now almost all do.
It’s also more affordable.
Many clinics now offer self-pay packages, which include tests, the operation, aftercare, anaesthetic and hospital care, for a fixed price. ‘Packages are increasingly popular because there is more certainty about the costs and fewer invoices,’ says Jack Griffin from the Private Healthcare Information Network (PHIN).
It’s still worth checking the small print, however.
Griffin says: ‘There may be costs involved because of extras, say if you need extra physiotherapy or another follow-up scan.
‘So it is important to determine exactly what is included in the package.’
Other experts say it is also worth finding out the individual price of everything, to see if you really are making a saving by going for a package.
An initial appointment with a consultant – costing between £100 and £250 – is usually charged separately, package or no package.
The doctor must then write to you outlining the full cost of treatment they recommend.
How do I find a private doctor?
Experts say a good place to start – if you think you want to go private – is, in fact, with your NHS GP.
‘GPs often have a good idea of the local private clinics and might be able to recommend a surgeon or consultant who sees patients privately,’ says Griffin.
‘Many private hospitals will request a referral from a GP or other doctor anyway before they can take you on as a patient.’ You might know what’s wrong with you – and what kind of treatment or procedure you need.
But you might feel unwell, or find a lump or have another worrying symptom, and not know the cause.
Most private healthcare companies offer fast-track GP appointments, both online and face-to-face, costing between £50 and £150. Bupa (bupa.com), for instance, offers in-person GP consultations – often within a day – costing £70 for 15 minutes, and £128 for half an hour. Nuffield Health (nuffieldhealth.com) offers similar same-day services at multiple locations nationwide.
Experts say the benefit, in many instances, is that everything is under one roof.
You can go straight for a blood test in the building if a GP recommends it – of course, at an added cost. If you want to choose your own consultant and contact them directly, myhealthspecialist.com lists only private surgeons and doctors – searchable by speciality – who have been recommended by other doctors.
Is your surgeon up to scratch?
PHIN (phin.org.uk) allows you to search private doctors by name – and may give you information such as the number of procedures they’ve performed and the medical, regulatory bodies they are registered with.
The National Joint Registry (www.njrcentre.org.uk) offers the same for hip and knee surgeons.
You can also examine reviews written by former patients of your chosen doctor at iwantgreatcare.org or doctify.com.
If the data isn’t published for a particular consultant, experts suggest contacting the hospital to ask them to supply the information – surgeons have been obliged to publish their outcome data since 2013.
It is also a good idea to check the consultant is registered with the relevant medical college – such as the Royal College of Ophthalmologists for eyes, or the Royal College of Surgeons for joints.
So how much should you expect to pay, and what do you (or should you) get for your money? Read on to find out.
A virtual GP when you like, but it will cost you £40
You’ll find GP services at private hospitals, but many high street names offer GP appointments – often via videocalls and often within 24 hours.
High-street giants such as Boots and Superdrug are just two examples, charging roughly £40 per appointment.
Boots offers its GP service via the Livi app – so you need a smartphone or tablet. If you use the code BOOTS10, you’ll only be charged £29 for an appointment.
Superdrug’s The GP Service works via the retailer’s website (superdrug.thegpservice.co.uk) so you can use a laptop or computer with a webcam – or a smartphone or tablet.
High-street giants such as Boots and Superdrug are just two examples, charging roughly £40 per appointment
All the major private insurance companies offer 24/7 virtual GP appointments for free to their policy-holders.
Appointment times can be in evenings and at weekends – but private GPs are more likely to spend longer with patients.
The NHS offers a similar service, called GP At Hand, which allows patients to book GP appointments on their smartphone or at a local clinic, for free.
Be warned, though.
Registering for free with GP At Hand will mean the service replaces your NHS GP.
Pay a subscription fee – £149 per year – and you can use the GP At Hand service and keep your NHS doctor.
‘I spent £12,000 on a new knee’
Artist Debbie Plaskett, 61, paid £12,000 for a knee replacement in February last year, after being told she would have to wait two years to have it done on the NHS.
The married mother-of-one from Norfolk was diagnosed with osteoarthritis in both knees in November 2019 after being referred for an X-ray by her local GP.
She says: ‘I was in agony – there was basically no cartilage left inside my knee joints. I was told my only option was surgery. I’ve always been outdoorsy but I wasn’t even able to go walking with my three greyhounds. I was devastated.’
Artist Debbie Plaskett, 61, paid £12,000 for a knee replacement in February last year, after being told she would have to wait two years to have it done on the NHS
Debbie was booked in to have her right knee replaced on the NHS, but had to wait until January 2021 for the operation.
The surgery was a success, but when she went to see her doctor for a follow-up appointment, he told her she’d have to wait up to two years to have her left knee done.
‘He said I’d be better off going private if I could,’ says Debbie. She contacted her local BMI hospital, which offered her an interest-free credit agreement, as long as she paid half up front. She made the down payment using a credit card.
Although both of these will take several years to pay off, she says: ‘I took the view that I could spend two years of watching my spending or two years not being able to walk. I always feel I made the right decision – especially after seeing how long the waiting lists for NHS treatment are now. I’m back to being able to walk as far as I want without taking any painkillers.’
Just how much will hip surgery set you back?
Finding out the cost of surgery isn’t always straightforward. We used price-comparison websites and contacted hospitals to find the highest and lowest prices for the most common private procedures.
The differences are often stark – smaller hospitals and those in the North of England are generally cheaper, compared to those in London, the South East and South West. However, this isn’t always the case, so it’s worth shopping around. The difference between hospitals even within the same city can amount to thousands.
Jump the year-long queue for new hip
By far the most popular paid-for procedures are knee and hip replacements. NHS patients can expect to wait an average of about four months for orthopaedic surgery, but 56,000 are facing delays of more than a year.
How much does it cost?
Prices of hip replacements vary widely depending on region. Hospitals in the South West and South East tend to be more expensive – charging up to £15,500 per hip.
The East Midlands seems to be the cheapest, with costs starting at around £9,000. Knee replacements cost upward of £19,000 per knee in some London hospitals, and as little as £9,000 in Margate.
What else do I need to know?
Be aware of extra charges for diagnostic tests.
An MRI scan – the basic scan that can detect arthritis in the knee or hip – will not show if the joint is damaged and in need of replacing.
Consultants may order more tests, such as a CT scan, which takes detailed pictures of the knee or hip, to determine whether a replacement is really needed.
Diagnostic tests are sometimes not included in a package, and can incur extra charges of between £300 and £1,000.
And while consultants must tell you the cost, they often do not know exactly.
Be sure to check with the medical secretary at the hospital first.
‘My savings got me back in the swing’
Paul Nelson, 81, from Dorset, spent two decades stashing away money in case he needed an operation.
About 25 years ago, the father of-four cancelled his private health insurance when the provider doubled his fee to £140 a month, and instead put that amount into a tax-free ISA account every month.
In August 2020 his savvy decision paid off, when he suffered a slipped disc in his lower back.
Paul Nelson, pictured, from Dorset, saved £140-a-month in a tax free ISA in case he required private medical treatment. After 25 years, he was able to fund his back surgery and returned to the golf course within six weeks
‘One night I went to bed completely fine and the next morning I woke up in agony,’ says the former soldier.
‘There was a sharp pain in my leg, which meant I struggled to walk more than a few yards.
‘I’m usually very active and I couldn’t cope with the idea I’d be stuck to the sofa for the rest of my life.’
Paul didn’t bother visiting his NHS GP and instead used his savings to pay for a private MRI scan at his local hospital, costing £300.
He took the results to a private GP – the consultation cost £150 – who told him he needed decompression surgery, which relieves pressure on the nerves in the spine.
The GP said he could expect to wait at least a year to have the surgery on the NHS. ‘I knew I had the money so I didn’t have to worry about it,’ Paul says. In mid-December 2020, he had the £8,500 surgery at Spire Hospital in Southampton.
He says: ‘After six weeks, I was fit enough to play golf again. I definitely made the right decision.’
Nearly £2,000 to fix your cataracts
At least a third of Britons have a problem with impaired vision, the most common being cataracts – when the eye’s natural lens becomes cloudy.
But accessing a simple procedure to resolve this on the NHS is increasingly difficult, with roughly 600,000 waiting for treatment. It is no wonder that private healthcare brokers say that cataract surgery, where the lens is replaced, is another popular paid-for procedure.
Glaucoma, where a build-up of fluid damages the optic nerve at the back of the eye, is another common eye condition, affecting one in 50 over-40s, and one in ten over-75s. It results in blindness if untreated.
Treatment involves draining the excess liquid in the eye, either by stimulating the drainage tissue with a laser, or by creating a tiny hole in the eye to expel the fluid via surgery.
How much does it cost?
Costs vary between roughly £1,800 and £3,500 per eye, depending on your area and type of lens you choose. Multifocal lenses (which essentially allow you to live glasses-free) are about £1,000 dearer than monofocal alternatives, which are set to a fixed focus for one distance.
Laser procedures for glaucoma cost between £500 and £1,000, while surgery can be up to £5,000 depending on severity.
What else do I need to know?
Cataract procedures are among the safest. But there is a common complication which occurs in one in ten patients, potentially resulting in extra costs.
With severe cataracts, the surgeon may not be able to remove all the damaged lens in one go.
In these cases, there is a risk remaining cells will grow on the back of the new lens, affecting vision – a condition known as posterior capsule opacification.
If this happens, a second procedure may be needed.
Not all providers will include a follow-up corrective operation in the final costings, so check beforehand.
‘If there is a complication and you don’t want to go back to the private provider, you will still be eligible for NHS treatment,’ adds David Hare, chief executive of the Independent Healthcare Provider Network.
Patients seeking to jump the NHS waiting list for a knee replacement can expect to pay £12,000 for surgery
However, if you do suffer problems, and need another operation on the NHS, you’ll be back on that waiting list.
As for glaucoma, it is worth having a test done at the optician before deciding on treatment, to check the pressure of the fluid in your eye. If the pressure is below 25, experts say there is little risk of permanent sight damage if you wait a month or two for treatment – so it may be worth sticking it out on an NHS waiting list.
Even if the pressure is 25 to 29, you can wait a couple of weeks. Anything above 30 should be treated immediately.
Don’t hang around for hernia repair
Roughly 10,000 NHS patients who need a hernia repair, or similar surgery, have been waiting at least a year.
There are three different types of hernia: inguinal, where a piece of the gut or fatty tissue bulges through a weak spot in the groin muscles; hiatus, where the stomach slips upward through a weakness in the diaphragm muscle that usually holds it in place, causing acid indigestion; and umbilical – where the bulge happens because the intestine pushes through the muscles in the abdomen near the belly button.
How much does it cost?
With all hernia repair, once the protruding tissue is pushed back into place, a piece of mesh is attached to the weak area of muscle to strengthen it.
The cost depends on the type of hernia. Hernias in the groin and hiatus hernias tend to be slightly more expensive than umbilical hernias.
This is largely because surgeons will often repair inguinal and hiatus hernias using minimally invasive, keyhole techniques, called laparoscopic surgery, to avoid a large scar and reduce the risk of infection.
Prices for hernia repairs range from £2,000 to £10,000, with the average around £5,000 for a laparoscopic procedure.
What else do I need to know?
There are a number of new methods of repairing hiatus hernias, some of which come with eye-watering price tags. Usually, the problem is resolved by pushing the stomach back into position, and wrapping the upper part of the stomach around the oesophagus to create a tighter sphincter, stopping food and digestive juices moving back and forth to the throat.
But some hospitals claim using implants – such as special hoops to tie around the oesophagus – leads to better, longer-lasting results. Parkside Private Hospital in Wimbledon, South London, is charging nearly £10,000 for its procedure that promises to resolve the problem using a new device made of titanium beads, used to keep the closure extra tight.
The technology is not widely used within the NHS. What’s more, don’t be fooled by surprisingly cheap inguinal operations. We found that some that were priced very competitively – under £2,000 – do not use laparoscopic methods. This means the procedure involves a large incision, greater risk of complications and days in hospital.
The high cost of varicose veins treatment – and it might not work
Varicose veins are bulging, purple blood vessels in the legs and ankles caused by poor circulation. Treatment for them has long been a popular paid-for service.
Varicose veins affect 40 per cent of the population – and while NHS GPs will refer patients for a procedure if they suffer aching, swollen legs or itchy, damaged skin, they won’t if it’s considered a purely cosmetic problem.
How much does it cost?
There are several ways to treat varicose veins, each with a different price tag. The most common is ablation therapy.
This involves having a narrow tube, or catheter, threaded into the vein via a small cut above the knee, where a hot probe is inserted. This destroys the problematic vein.
Ablation costs anything from £750 up to £3,000 per leg. For smaller veins, doctors may recommend something called sclerotherapy, where foam is injected into the veins. This causes scarring which eventually closes off the vein. Sclerotherapy costs between £200 and £600 a leg.
One leading specialist has recently begun offering a new, non-invasive technique called echotherapy, which uses heat to shrink and close off the veins. But here, the heat is able to penetrate the skin from outside the body.
Vascular surgeon Professor Mark Whiteley is the only clinician to offer echotherapy – at his Whiteley Clinic centres in London, Guildford and Bristol – costing from £3,039.
What else do I need to know?
While non-invasive options like echotherapy may seem tempting, due to the little downtime after the procedure, it is new – and not yet gold standard. Studies show the success rate for ablation operations are between 85 and 95 per cent, and they are standard on the NHS.
While sclerotherapy may be cheaper, the success rates can be as low as 50 to 60 per cent, raising the risk of further procedures.
Stop gynaecological discomfort
Waiting lists for NHS gynaecological treatment have risen by 60 per cent since the beginning of the pandemic. Today, one in 20 of those with painful conditions such as fibroids, cysts and endometriosis, or who are in need of a hysterectomy, are facing delays of at least a year for treatment.
The most common treatment for fibroids – non-cancerous, fibrous growths in the womb that don’t respond to medication – is a procedure to remove them.
This can be surgery, with cuts made in the abdomen, or non-surgical techniques that block the blood supply to the fibroids, or embolisation. The removal of cysts and tissue related to endometriosis – in which cells that usually line the womb grow elsewhere – almost always involve keyhole surgery. Hysterectomies, which are sometimes performed to treat fibroids, can be performed using keyhole techniques too.
How much does it cost?
Surgical procedures for fibroids and cysts cost between £5,000 and £10,000, depending on the location and time needed to recover in hospital.
Some providers charge less for a more minimally-invasive procedure, done via keyhole surgery, involving less downtime in hospital and fewer scars.
Other techniques, such as embolisation which cuts the blood supply to the growths, or procedures that destroy fibroids using heat energy, cost from £8,000.
The cost of endometriosis treatment ranges from £5,000 for standard laparoscopic, or keyhole, surgery, and £10,000 for robotic surgery.
It can cost up to £25,000 for very complex cases.
Private hysterectomies range from £4,000 to £8,500.
Procedures that involve major surgery, removing the womb via a large cut in the abdomen, cost more than those that extract it via the vagina or a small cut in the groin.
What else do I need to know?
Non-surgical fibroid treatments are not as well evidenced as traditional, surgical techniques.
They are only deemed suitable for women who do not wish to have more children, due to unknown risks to fertility.
When the procedure is not performed by a highly-experienced specialist, ten per cent of patients suffer complications.
Be sure to choose your consultant wisely – a good surgeon will be able to boast a one per cent failure or complication rate, research shows.
Many private consultants offer a two-in-one package for diagnosis and treatment of endometriosis.
The troublesome tissue is cut out via a keyhole incision, but some providers will charge more for complex endometriosis extraction. The extent of the problem is often impossible to predict, so be aware of potential extra costs.
Time to tackle prostate problems
Roughly one in three British men over 50 suffer an enlarged prostate. The walnut-sized gland sits below the bladder, and if it swells it can cause problems with going to the toilet – needing to go all the time, but often not being able to.
Complications include recurrent urinary tact infections and severe pain.
Yet, the thousands who do not respond to medication can expect to wait at least four-and-a-half months for one of many procedures that could resolve the problem.
How much does it cost?
The most common procedure is transurethral resection of the prostate (TURP), whereby part of the prostate gland is removed. The surgery, including one to three nights in hospital, costs between £3,000 and £9,000, depending on location. The average price is about £6,000.
Also popular is a minimally invasive option such as UroLift – where a surgeon inserts an implant to hold the prostate away from the bladder, relieving symptoms in just 15 minutes. Expect to pay about £5,000.
Prostate artery embolisation is also popular, as it is performed under local anaesthetic, involving little to no downtime. The procedure, which costs between £6,000 and £8,000, involves injecting particles into blood vessels via a tube in the groin. This cuts blood supply to the prostate, shrinking it.
What else do I need to know?
Most of the surgeons offering UroLift – which are performed in a day clinic – are based in the South of England. Prostatematters.co.uk has an extensive list of urologists experienced in the procedure.
Studies show that in about ten per cent of cases, prostate artery embolisation can fail if the blood vessels are too weak or thin to take the injections. In these cases, doctors may suggest patients have TURP, which means paying twice or waiting at least four months to have surgery on the NHS.
Piles causing pain? Don’t sit around
Embarrassing problems that affect the back passage, like haemorrhoids and fissures (small tears in the skin), affect at least eight million Britons. Yet patients face lengthy waits to have them sorted, as NHS GPs often consider them non-urgent. New treatments like those using heat to destroy haemorrhoids are not offered on the NHS.
How much does it cost?
Procedures for haemorrhoids cost anywhere between £550 and £3,000 depending on the type of treatment you choose.
Full surgery – a haemorrhoidectomy – is around £2,700, including an overnight in hospital if needed.
Less invasive procedures such as banding – where tiny rubber bands are placed inside the back passage to cut off the blood supply to the haemorrhoids – are cheaper, as they are over in a few minutes. The average price is roughly £1,500, including a follow-up appointment. Newer, non-invasive treatments, involving hot probes which starve the piles of their blood supply, cost around £2,000.
For very small haemorrhoids, doctors may suggest injections which cause the piles to shrivel up and vanish in weeks. The average cost is roughly £300.
For anal fissures, procedures range from £1,500 to £3,500, depending on recovery time in hospital and the method used.
What else do I need to know?
Non-invasive treatment for haemorrhoids may not resolve the problem in one procedure, you may have to pay for a second intervention.
What about scans and tests?
Private diagnostic services are a fast-growing area. A report published last week by private health sector analysts LaingBuisson noted that private MRI and CT scans have jumped in popularity by at least 50 per cent in the past year.
Detailed scans can be useful to spot everything from spinal fractures to joint problems and cancerous growths deep within organs.
Then there are private blood tests, which have exploded in popularity over the past few years – with multiple online providers checking for everything from hormone health to nutritional deficiencies with a finger prick.
Private hospitals have their own in-house blood-testing services too. Simply pay for your blood test online and make an appointment at the local hospital within three days. The results are usually sent out within a week.
How much does it cost?
CT scans, also called CAT scans, cost between £400 and £900. They use X-rays to produce detailed images of tumours, bone fractures and internal bleeding, and take between ten to 20 minutes to complete, depending on the location.
MRI scans produce slightly more detailed images of soft tissue and bone, and tend to be slightly cheaper, priced between £200 and £800. They are more uncomfortable, as you have to lie still in a tube for up to 90 minutes.
Blood tests range from £25 to £300, depending on what exactly the provider is testing for.
What else do I need to know?
Traditional ‘closed’ MRI scanners – the type where you lie on a bed which is then slid into a tube – tend to be about £200 to £300 cheaper than open ones, which you can walk into.
Open MRIs are popular with people who feel claustrophobic, but they are not as widely available.
It is a good idea to visit your GP for a referral for any scan or blood test, as some private providers charge extra if you don’t. Nuffield Health, for instance, charges £25 for patients who require a blood test without a GP referral.
Most private services do not include a full debrief from a consultant who can explain your results – the data is sent to you online, along with a basic, written interpretation. But you can arrange for the results to be shared with your NHS GP, who can discuss them for free.
We got £20,000 cancer drug paid for… and FOUR extra years
When Ed Jones was diagnosed with a brain tumour at the age of 50, his private insurance gave him access to a drug that he’d have been denied on the NHS – and an extra four years with his family.
His widow Sue, 51, left with Ed on their wedding day, recalls: ‘Our two daughters were five and eight at the time. I worried they wouldn’t remember their father – but we had those precious four years, which we’re all still grateful for.’
Ed, who worked as an IT manager, began experiencing regular faints in early 2012. He had private health insurance through his work and saw a neurologist. An MRI scan revealed he had an aggressive brain tumour – and was told he could be dead within 18 months.
When Ed Jones, pictured right on his wedding day with wife Sue, left, was diagnosed with a brain tumour at the age of 50, his private insurance gave him access to a drug that he’d have been denied on the NHS – and an extra four years with his family
Thanks to his insurance, he was able to get a drug called Avastin (bevacizumab), which costs about £21,000 per year and is not available on the NHS for brain tumours.
Since her husband’s death in 2016, Sue has taken out private health for £250 a month to cover her and her daughters. ‘It’s something I would never give up. I believe my husband was given more time due to having private health insurance,’ she says.
Want to save on health cover? Let your insurer choose your surgeon
Jump the queues for an operation, speak to a GP whenever you want – even get access to eye-wateringly expensive life-extending cancer drugs that aren’t routinely prescribed on the NHS.
It’s not difficult to see the appeal of health insurance, and demand has never been greater. Insurer Vitality has seen an astonishing 35 per cent spike in customers over the past year, twice what they saw the year before. Axa PPP saw a 20 per rise.
Put simply, medical cover pays out for private treatment should you fall ill. But with a bewildering array of policies out there, at a wide range of prices, how do you know which one is best and, crucially, whether you’re being sold things you don’t really need?
Beware price comparison sites
Even a simple internet search for ‘private health insurance’ can throw up problems, warns Brian Walters, director of medical insurance brokers Regency Health.
‘Google search results can include price comparison websites run by companies which, once you fill in your details, will simply sell your data on to private healthcare companies which then bombard you with calls,’ he explains. ‘A rule of thumb – never put your details into a website that doesn’t have an easily visible phone number.’
You can go directly to insurers for a quote – the ‘big four’ are Axa PPP, Aviva, Bupa, and Vitality – or, far better, find an independent broker who can give expert advice and help secure a policy.
Which? Magazine produces a comprehensive private healthcare guide that recommends the broker route.
The British Insurance Brokers Association (biba.org.uk) and the Association of Medical Insurers and Intermediaries (amii.org.uk) websites both lists dozens to choose from. All of them have been vetted, and are regulated.
What’s covered… and what’s not?
Health insurance can be wide-ranging, covering surgery, but also outpatient treatment, virtual GP services, cancer care, and even things such as physiotherapy, acupuncture and mental health services, depending on the policy.
The one thing they all have in common, however, is they won’t pay out for pre-existing conditions.
Some insurers will ask to see your medical records – with your permission, they’ll get in touch with your NHS GP.
‘Others may ask you to detail any treatment you have received over the past five years and exclude these from a policy.
It’s vital to be aware of the small print, says Walters.
‘If you have diabetes, you’ll have regular check-ups and medication and none of that will be covered.
‘But there are many other problems that are related to diabetes – eye problems, poor healing wounds and heart issues to name a few. None of these things will be covered either because they’re related to the pre-existing condition.’
When signing up for insurance, you can negotiate a moratorium, which means treatment related to a pre-existing problem can become covered over time, but only under very specific circumstances.
‘Moratoriums have stringent conditions,’ says Walters. ‘They require you to not have had any treatment for, or seen a doctor about a specific problem, for two years before they’ll cover it.
‘But that means no repeat prescriptions or a check-up. Many people don’t realise this.’
However having insurance can still pay off, adds Walters.
‘You might have exclusions for prostate problems or diabetes-related issues, but then develop bowel cancer, which you could claim for,’ he says.
Age and extras that push up premiums
Most insurers provide a basic policy that you can add or remove services from. The kind of care that’s covered, along with age and where you live, are what influences monthly premiums.
What happens if something goes wrong
Most private providers will cover you if something goes wrong during the operation, or if there is a complication.
Some have time limits on this – for instance Aspen Healthcare will only fund revision surgery or complications that arise up to three months after an operation. Problems that occur outside this time frame will be assessed on an individual basis.
If urgent problems arise while in hospital, such as infections and septic shock, doctors will transfer patients to an NHS hospital, as most private centres do not have facilities for emergency care.
If a patient is at risk of surgical complications, doctors may choose to perform an operation in an NHS hospital with a private wing.
‘The cost of hospital care is highest in London and lowest in Scotland, so premiums reflect that,’ says Walters. ‘Premiums increase by roughly ten per cent every year, so they’re quite a lot more expensive as you get older and become more likely to claim on them.’
The other thing that can push a premium up sharply is making a claim. ‘If you claim on your insurance you can expect to see your premium rise by up to 50 per cent the next year, although some insurers, like WPA, do offer a policy that is not affected by claims,’ says Walters.
Basic policies rarely include outpatient appointments or diagnostic tests, but these can be covered – although it can add hundreds of pounds a year, or even double your premium. Insurers used to offer plans where customers agreed they’d seek NHS treatment in the first instance, and only claim if there was a treatment delay of more than six weeks.
When the pandemic hit and waiting times for NHS treatment began to soar, most companies axed these policies.
Instead, most now offer ‘guided’ or ‘directed’ policies – where the insurer tells you which consultants and hospitals you can use, from a selected list. These plans can reduce monthly premiums up by to a third, meaning a substantial saving.
Walters says: ‘The big worries clients have about these plans is that they’ll be made to travel miles from home for treatment, which doesn’t happen, and that they’ll just get given the cheapest doctor. This isn’t the case either.
‘Insurance companies tend to pick very good surgeons. They don’t want to have to pay out for repeat operations, so they want doctors who get it right first time.’
As for companies trying to wriggle out of claims, Walters says this is a misconception: ‘Medical insurance isn’t cheap, but companies have a good track record for paying claims.’
Don’t turn down cancer cover
Insurers often offer to reduce monthly premiums by removing or limiting the amount that can be spent on cancer care. Walters advises against this.
‘Cancer care is where private medical insurance really comes into its own,’ he says. ‘Things like chemo and radiotherapy are costly enough, but newer therapies be extremely expensive – so much so they might not be available on the NHS.’
Several of Walters’ clients who have developed cancer have made claims at about £100,000. Two had claimed for treatment that cost £250,000 and there was one claim for £500,000. ‘Private insurance will cover most medicines as long as they’re licensed,’ Walters adds.
Source: Read Full Article