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How to use your private health insurance

Whether you have your own private medical insurance policy or are covered through your work, our guide explains how to make a claim for treatment at a Circle Hospital, so you can get fast access to private healthcare when you need it most

close up of GP writing on medical notes
At the point where you need to see a specialist for treatment, you can choose to activate your private health cover, using it to pay for treatment at one of our private hospitals.

Making a claim on your health insurance is easier than you think. With Circle Health Group, there are just three simple steps to accessing private treatment using insurance:

1. Speak to your GP

When you have an appointment with your GP, let them know that you have private insurance, and ask them to refer you to a Circle Health Group hospital.

If you have already chosen the consultant you want to see, you can let your GP know so that they can give you a specific referral letter. This should include the hospital and the consultant, as well as the recommended treatment you need.

They can also give you a more general referral letter that doesn’t specify a consultant.

2. Speak to us

If your doctor has given you a referral letter, call our appointments advisor line on 0800 096 2906. Or if your doctor contacts us directly with your referral, we will get in touch with you, usually on the same day.

3. Speak to your insurer

Don’t forget to call your insurer after visiting your GP to activate your insurance. Have your referral details to hand when you call, as your insurer will need this information to confirm that the treatment you need is covered by your policy.

(If you find that the treatment is not covered by your provider, but you still want to go private, you can simply pay for your own healthcare.)

If at any point you’re finding the process more complicated or confusing than it should be, we’re here to help. Call us on 0800 096 2906 and one of our friendly team can help you get things sorted.

Private health insurance (also known as private medical insurance or PMI) is cover designed to make sure that if you need medical treatment, you can go private for your care and not worry about the costs.

So, if you need private treatment, your PMI covers the costs. You can get fast access to expert care, safe in the knowledge that the price will be covered by your policy.

Personal private healthcare insurance is paid for directly. You might pay monthly instalments or an annual fee. Lots of people have cover through their work, in which case your employer will deal with the insurance provider. You might pay a fee each month for the policy, but this will likely come out of your salary before you are paid.

What is private healthcare?

Private healthcare refers to hospitals and clinics that are not run by the NHS. Some of them do work very closely with the NHS, but they are run independently. You might also hear private hospitals referred to as independent hospitals.

Circle Health Group offers private healthcare at more than 50 hospitals and clinics across Scotland, England and Wales.

Find your nearest Circle hospital.

How does private healthcare work?

You’ll find everything you need to know in our guide to private healthcare.

Many people have health insurance without even realising it.

A lot of companies offer private health insurance to employees as standard, so you should check at work to see if that’s the case. Ask around your family, too, as many people have a corporate health insurance policy that covers close relatives (for example parents, partners and children).

It is also common for people to have health insurance, whether personal or corporate, but not use it. There are many reasons for this (see below in our FAQs for more information), but in most cases it’s best to take advantage of insurance if you have it.

Private health insurance is there to be used! If you don’t have private medical insurance and are looking to invest in your health, you’ll find more information on how to do so below.

However, if you already know you need treatment, but don’t yet have health insurance, buying a new policy will not cover the treatment you need. Instead, take advantage of our pay-as-you-go healthcare offer, which includes options to spread the cost of treatment.

Yes, most private healthcare providers in the UK will need to see a GP referral before authorising your treatment.

If you would prefer not to wait for an appointment with your usual GP, you can see a private GP via a video consultation to speed up your referral.

Once you have a referral, you should be able to use your private health insurance to pay for treatment at any of our private hospitals, with any of our consultants.

Once you have spoken to your private medical insurer, you can book your appointment with your chosen hospital or clinic. Just give us a call on 0800 096 2906.

When booking your appointment with us, we recommend you have the following details to hand:

  • The name of your private medical insurer
  • Your membership number
  • Pre-authorisation code (where provided)
  • The name of the consultant you would like to book, if known. Don't worry if you haven’t already chosen your consultant, our team can provide a list of the names of specialists available
  • Dates and times when you’re available to have an appointment

We work with all major private healthcare providers in the UK and also with a variety of international insurers. Below is a list of the providers we work with most frequently.

If your health insurer isn't listed, simply give us a call on 0800 096 2906, and we can quickly let you know if we work with your provider.

Aviva PLC

AXA Health

Bupa

Cigna

Vitality

WPA

What is covered by your insurance will differ depending on which private medical insurer you are with and what your policy includes.

Most policies will cover:

  • Major treatments and operations
  • Consultations
  • Diagnostic tests such as X-rays, scans and blood tests
  • Physiotherapy and other aftercare deemed necessary for your recovery

PMI tends to cover ‘acute’ conditions, which means diseases, illnesses or injuries that are likely to respond quickly to treatment, returning you to the state of health you enjoyed previously. That can mean that long-term illnesses fall outside of your cover.

These days, many policies will also offer support for mental health problems and psychological treatments.

It’s important to know that pre-existing conditions are not usually covered either. You will have to give a detailed medical history at the time of purchasing your policy and any conditions or problems you already know about will be excluded from the offer.

If you do want cover for an ongoing or long-term condition, it’s best to speak to a provider directly, and they may be able to tailor the policy to accommodate your needs.

What if my insurance doesn’t cover the treatment I need?

If your insurance policy does not cover the treatment you need, you can still go private with Circle Health Group.

We offer a pay-as-you-go option, known as self-pay. Within this offer are flexible payment options that make the costs of private treatment more affordable than you’d think.

Health insurance gives you access to private healthcare when you need it, meaning you always have the reassurance that you and your family can get quick, expert treatment should you need it. Many people see it as an investment into their health and wellbeing.

Because you pay for health cover, you won’t need to worry about the costs of private care at the time of treatment. Your insurance provider will liaise directly with our dedicated team to sort out everything to do with prices of treatment, and you can focus on getting better.

Why go private with Circle Health Group?

The benefits of private healthcare with Circle include:

  • The ability to choose the consultant and the hospital you want
  • Fast access to treatment, without long waiting lists and delays
  • Consultant-led treatment plans, tailored to your individual needs
  • Expert care in a calm and peaceful environment
  • Comfy private hospital rooms with en-suite facilities, TVs and WiFi as standard
  • Delicious, healthy meals tailored to your dietary requirements
  • Additional services such as pharmacy, imaging and diagnostics, and physiotherapy on-site

Find out more about the benefits of private healthcare.

This is a personal decision, based on your budget and the level of reassurance and 'extras' you may want. Essentially, the more you want your insurance company to cover, the more you will need to pay. So, start with these questions:

  • What's your budget?
  • Do you want to pay for the first part of any treatment? (If you do, agreeing to an 'excess' can cut your premiums significantly.)
  • Do you want to include outpatient costs such as specialist consultations, X-rays and blood tests?
  • Would you like a choice of hospitals, or would you agree to one nominated by your insurer?
  • What types of treatment do you want to be covered for? Some people want to cover most eventualities. Others cut the cost by regarding private health cover for major treatment only. Others strike a balance between the two.
  • Do you want to include your family in your cover? You can tailor medical insurance to your exact circumstances. So, whether you're single or married, with or without children, you can cover the people who are important to you.

If you’re still uncertain, you can speak to an independent adviser, who will help you find the best insurer for your personal circumstances.

There are many different health insurance plans available , and we are not here to advise you on which plan is best for you or which health insurance providers are the best choice. This is just a quick overview of the process of buying private healthcare insurance.

1. Choose the level of cover you want

Answer the questions in the ‘how much insurance cover should I buy?’ section above, and think about your answers in terms of importance. Which elements are an absolute necessity, and which will you be flexible on?

2. Choose your insurance provider and policy

It’s always best to do as much research as possible into what is offered by different insurance companies and what their different products cover when it comes to medical treatment.

A quick internet search will help you find various price comparison websites that will help you narrow it down and identify which options could work for you.

There is also the option of using an independent adviser, who can look at a wide range of insurers and make a recommendation based on your particular circumstances.

Apply for your medical insurance policy

Once you've chosen the right product for you, you'll need to complete an application. In it, your insurer will ask you some fairly detailed questions about your health. They may also ask your permission to write to your doctor.

Do make sure you complete the application truthfully and fully. If you're not sure whether to mention something, it's best to do so just in case. Remember, if the insurer feels you've left out or concealed something, you may find they refuse a claim in the future - or even cancel your policy.

We answer some of the most frequently asked questions about private medical insurance, from what is covered by insurance policies, to whether your insurance premiums will go up if you make a claim.

How much is private healthcare in the UK?

Private healthcare costs in the UK depend on various factors, including:

  • Where you have treatment
  • What treatment you need
  • Which consultant you have treatment with

You’ll find more information on our guide to paying for treatment with Circle.

If you are looking for the cost of different health insurance plans in the UK, you can use an online comparison website, or you could speak to an independent adviser. The price of medical insurance will be different for every person.

Do you offer Circle insurance?

We don’t offer our own private health insurance to individuals, however you don’t actually need private medical insurance to access treatment with Circle Health Group. You can simply pay for whatever treatment you need, as and when you need it.

Find out more about paying for your own treatment.

How do I get medical insurance?

You can purchase PMI easily online, whether direct from a private healthcare provider or by using a price comparison website. You can also go to an independent adviser, who will seek out the best deal for your individual circumstances.

What does private medical insurance cover?

In general, private health insurance covers 'acute' conditions. That is; diseases, illnesses or injuries that are likely to respond quickly to treatment and return you to the state of health you enjoyed before the condition occurred.

I've had health problems before. Will that be an issue if I apply for medical insurance policy?

Generally speaking, a new policy will not cover you for problems that you have now or have had in the past. However, insurers are becoming increasingly flexible in their approach to covering individuals and do ask that in this situation you contact them and they will discuss the various options available to you.

These may include:

  • giving you cover and excluding specific pre-existing conditions
  • including your pre-existing conditions at a cost
  • excluding previous problems for a period of time before full cover is available

Are there any treatments that aren’t covered by private insurance?

All policies are different, but in general private health insurance is designed to cover treatment for curable, short-term illness or injury. It isn't for 'chronic' illnesses that are expected to need treatment over a long period. Most policies won’t cover (among others) conditions such as normal pregnancy, drug abuse, organ transplants, dentistry, cosmetic treatments, infertility, mobility aids, HIV/Aids, kidney dialysis or A&E.

What if I have a disability?

You will not be refused cover due to a disability. However, like any other 'pre-existing condition' you may find the policy excludes treatment that's needed because of that disability. But it must be fair and reasonable for the insurer to do this.

Does PMI cover treatment for cancer?

Private health insurance is a big reassurance if you receive a cancer diagnosis: you know you can get expert care at what is obviously a very worrying time. You'll find that some leading private health insurance providers will cover all cancer treatment costs, even if your illness isn't classed as 'acute'.

How can I be sure about what is and isn’t covered by my private medical insurance?

Your policy will come with a full document, together with a key features summary. This will make it clear what's covered, what isn't, and the financial limits for any claim. If you're not happy when you first buy the policy, you can usually cancel it within 14 days.

Will there be lots of paperwork involved if I claim on my private health insurance?

No, that is very unlikely. Most insurers now use a paperless system, which makes the process efficient and simple.

Will my premiums go up if I make a claim?

Your insurance premiums may go up if you make a claim. Details of this can be found in your policy. They may also go up over time, whether due to inflation or because you are getting older.

If you receive your private health insurance through your work, there will be no change to your contributions as a result of making a claim.

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