Do you have private medical insurance?

Circle Rehabilitation is recognised by many of the major insurance providers. If you have private insurance, and would like to discuss how we can help you, please call us on 0118 922 6970 or email rehab@circlehealth.co.uk

What is private medical insurance (PMI)?

Private medical insurance (PMI) is an insurance policy designed to meet some or all of the costs of private medical treatment. Private medical insurance is often referred to as PMI, private health insurance, private health cover and health insurance.

PMI is designed to ensure that if you need medical treatment in the future, you won’t need to worry about NHS waiting lists or for self-funding the costs of your treatment. If you are treated privately, health insurance will pay all or some of your bills.

Health insurance covers many things including hospital scans, surgical procedures, inpatient treatment (staying overnight in a hospital bed) and medicines. However not all costs are covered in every situation, so it’s best to check with your insurer about any exclusions in your policy. For instance, insurers will not usually cover the costs of treating chronic or on-going conditions that you were aware of before you were insured.

There are many different insurance companies who offer various types of insurance cover. These can include specialist policies for over-55s, ones that focus on particular medical conditions or international policies aimed at expatriates living overseas. For information on other insurance terminology such as ‘indemnity’ or ‘cash plan’ policies, visit the Financial Ombudsman Service website here.

Why take out private medical insurance?

By paying an insurance company a regular amount, known as a premium, this prepares you for unexpected healthcare costs in the future. Insurance is designed to cover the costs surrounding unexpected illnesses, including most costs for private treatment.

Important reasons why patients choose to take out private medical insurance include: fast access to treatment, flexibility to choose the consultant you want to see and having the choice of a particular hospital which is convenient for you. There are many other advantages too, so find out more about accessing private treatment without the wait here.

We would love to help you with your recovery at Circle Rehabilitation. Let us assist you to create a bespoke package tailored around your needs.

Get a free 10-minute call with a specialist rehabilitation physiotherapist, based in Reading, Berkshire, and find out more about treatment for you or a loved one. Just enter your details here:

How information about you will be used
We will use your personal information to process your enquiry and contact you with relevant information. For further information, please see our website privacy policy.

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  • Policy

Your insurance policy is a document detailing the terms and conditions of your contract with your health insurance company. This usually details the duration of coverage, your premium amount and any exclusions. Your policy serves as legal evidence of your insurance agreement.

  • Premium

An insurance premium is the amount of money that you pay for your insurance cover – this is usually paid as a monthly instalment or as a lump sum for the duration of your policy. The amount of coverage that is included for the premium will vary by the type of insurance product among other factors.

  • Excess

An excess payment is a contribution you are required to pay towards a claim you make on your insurance policy.

The exact process and amount depends on your policy but most insurance companies will ask you to pay for the care that is under your excess amount directly to the healthcare provider.

  • Pre-authorisation code

You are likely to need pre-authorisation (approval) from your insurer at different stages of your treatment. For example, for an appointment(s), surgical treatment(s), test(s) and scan(s) etc. This is often to check they are medically necessary and covered in your policy. Sometimes this is also referred to as prior authorisation, prior approval or pre-certification. If you need access to a phone to call your insurer to get pre-authorisation for your treatment, test or appointment while you are visiting Circle, please ask a member of staff and one can be provided for you.

Depending on your policy, you may have approval from your insurer for just your first outpatient appointment only. Alternatively, this may include approval for any tests or scans your consultant refers you for. You can check your policy document for details or call your insurer to confirm.

Similarly, if you need surgery you will usually have to get additional approval from your insurer before your treatment is booked in. Don’t worry though, your insurance company will be able to talk you through the process and our team are on hand if you have any questions.

  • Shortfall

A shortfall is the difference between what a consultant charges for your treatment and what your medical insurance company is prepared to pay.

Some insurance companies have adopted a fee assured system or a capped pay-out scheme. This means the insurance companies set the fee for a named procedure or appointment. The price is only covered if the consultant you chose has agreed with the insurance company to work for this set fee. If the consultant you have been referred to, or you have chosen to see, has not agreed to work for the fee(s) the insurance company has set, you will have to pay the difference (known as a shortfall).

  • What do we mean by “inpatient”, “outpatient” and “day case”?

These three terms are determined by how long you’re staying in hospital for. As an “inpatient” you will stay in hospital overnight while you have your treatment. Your consultant will discuss this with you and let you know how many nights you should expect to stay in hospital.

As an “outpatient” you will simply visit hospital for your appointment and then head home afterwards. When you have your first appointment with a consultant, this is often referred to as an “outpatient appointment”.

“Day case” refers to when you need to stay in hospital following a procedure, but only for a short time during the day. You will then usually be discharged (sent home) on the same day as your procedure. However, sometimes a patient may have come into hospital for their treatment as a “Day case” but for clinical reasons will need to stay overnight, therefore becoming an inpatient. Quite often, your insurance company will need to be notified to approve the unplanned overnight stay.

Frequently asked questions

  • What is included under my insurance cover?

In general, health insurance covers short-term treatment designed to help you recover from illness or injury. Insurance usually only covers conditions that develop after you first took out your policy.

  • What is not covered under my insurance cover?

If you are aware of any medical condition you have before taking out insurance, this will not usually be covered by insurance companies. For instance, if you’ve previously had an injury, treatment or medical advice for a condition before taking out insurance, you may not be covered. This is sometimes referred to as a “pre-existing condition”. It’s always best to check directly with your insurer if you’re not sure.

Most medical insurance companies won’t cover treatment costs for chronic or on-going conditions. There will also be a list of “exclusions” to look out for on your policy, which are specific treatments not covered by your insurance. Examples include cosmetic surgery and A&E care.

You should check your policy and contact your insurer if you have any questions.

We would love to help you with your recovery at Circle Rehabilitation. Let us assist you to create a bespoke package tailored around your needs.

Get a free 10-minute call with a specialist rehabilitation physiotherapist, based in Reading, Berkshire, and find out more about treatment for you or a loved one. Just enter your details here:

How information about you will be used
We will use your personal information to process your enquiry and contact you with relevant information. For further information, please see our website privacy policy.

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