How does private medical insurance work in UK?

How does private medical insurance work in UK?

The exact procedure for getting medical help with your medical insurance can vary slightly depending on your specific plan and provider, but here’s a general breakdown of the usual steps:

1. Seek Medical Attention: In-Network vs. Out-of-Network:

  • In-Network: If you choose to use your PMI, it’s generally recommended to seek treatment from a consultant or hospital within your insurance provider’s network. This ensures smoother communication and potentially faster claim processing.
    • Check your network list: Your insurance provider should have a network list of hospitals and consultants you can access.
  • Out-of-Network (Potentially More Complex): While some plans might allow out-of-network treatment, it can be more complex and might not be reimbursed at the same rate as in-network providers.
    • Check coverage details: Carefully review your plan documents to understand coverage and reimbursement rates for out-of-network treatment.

3. Pre-approval (Optional, Check Your Plan):

  • Some insurance plans, particularly for specific treatments, might require pre-approval before you receive them. This verifies if the treatment is covered by your plan and avoids any unexpected out-of-pocket costs.
  • Contact your provider to inquire about pre-approval procedures if applicable to your plan.

4. Receiving Treatment:

  • Once you’ve identified a suitable consultant or hospital (in-network or following pre-approval if needed), schedule your appointment and receive treatment.

5. Payment (Depends on Your Plan):

  • Reimbursement (Most Common): In most cases, you’ll likely need to pay for the treatment upfront at the hospital or clinic.
  • Direct Settlement (Less Common): Some plans, particularly for in-network providers, might offer direct settlement where the PMI provider settles the bill directly with the hospital (you might only pay excess fees).
  • Refer to your plan details to understand your financial responsibility at the time of treatment.

6. Claim Submission (Reimbursement Scenario):

  • If your plan requires reimbursement, keep all receipts and relevant medical records.
  • Submit a claim to your PMI provider following their claim submission process (online portal, mail, etc.).
  • The provider will review your claim based on your plan coverage and limitations.

7. Reimbursement (Reimbursement Scenario):

  • Upon claim approval, you’ll receive reimbursement for the covered portion of the cost, typically deposited into your bank account.

Pro tip: Most medical providers typically reimburse your costs after the treatment. But first, you’ll need to pay for them out of your own pocket. That’s why it’s typically advisable to keep at least £5000 in your bank account for health emergencies (unless you choose to use NHS, which is still free). Worth noting that same applies to pet insurance!