There is one statistic which shouts out above all else when discussing private health cover or relying exclusively on the NHS. Currently, over 6 million people are waiting for treatment on the NHS. This represents more than 7 million treatment pathways. Longer waits for a diagnosis, and then treatment, will delay recovery. So, having opted for private cover, let us examine some of the inner workings in the system to better support the policy holder.
What is not generally appreciated by the public when dealing with the insurers is the degree of discretion that is built into the system. For example, when making a claim, the team assessing the eligibility of treatment under a policy are not necessarily medically trained. True, they are skilled to ensure that legitimate medical claims can be speedily processed, but as with many medical issues, things aren’t always clear-cut.
Here’s an example. One client’s family requested to stay for a further week in a West End hospital. However, the insurer argued that it would not alter the expected outcome for the patient. I protested to the insurer that the change of medication by the patient’s consultant could lead to a different – and more welcome – medical outcome. The insurer conceded and made my client happy.
One of the most misunderstood issues relates to pre-existing conditions, whether they are automatically excluded. The answer is that they may be, but also quite often, they are accepted for cover. What will determine the outcome is the type of underwriting the client adopts, and of course it is for the broker/intermediary to advise. All the insurers compete and this is reflected in their medical declarations which can result in one insurer accepting a condition while another would reject the same condition. One insurer we work with allows cover for associated conditions which arise from a pre-existing condition and which were not evident when the policy started, which is highly unusual.
How to reduce the premium is of interest to us all. Paradoxically, you will never hear of someone with home insurance complaining it was a waste of money as they had not been burgled, whereas some folks do see their premium as an unnecessary drain on financial resources when it’s unused. You may never be burgled, or suffer house subsidence, but we do become ill and it then becomes a matter of speed in accessing healthcare.
I would suggest that you always try to negotiate with the insurer at renewal time for a lower premium. This is best achieved by demonstrating cheaper equivalent cover elsewhere, which you can ask an intermediary to do. We never charge for our services, so do get us to do the work! Generally speaking, the insurer wants to retain you as a client. Do consider, when starting or renewing a policy, whether you could be happy with a smaller hospital list, or perhaps try reconfiguring the outpatient cover to make it more affordable. All schemes are modular, so adding and subtracting benefits are built into the system.
Are the extras worth it? These would usually comprise therapies, mental health cover, travel cover and no-claims discount protection, and dental and optical. These can be relatively inexpensive to add to a policy but could be expensive if self-paying, with private mental health care being inordinately expensive.
Explaining premium increases is slightly trickier and not scientific, as the insurers use different modelling to actuarially assess a client’s pricing. A quick user guide to this phenomenon would be A, B, C.
A stands for an increase in age, based on the premise that as we get older, we are statistically more likely to have more medical issues and which may also include a risk factor. B would be broad medical inflation. Here, it is more difficult to be say which insurer is better than any other, although they will vary year to year. C stands for claims and here certain incorrect suppositions exist. Where there is a high medical claim, the insurer is not necessarily trying to recover that money as soon as they can. They accept by and large that some clients will need a great deal of medical support, some less so and some not at all.
Trevor Gee is managing director of Patient Health, patienthealth.co.uk