How does private health care/insurance work?

Jlawson118

Complete newbie to this sort of thing but I'm considering signing up.

I'm just really angry at the way the doctors and general hospitals are treating myself and my family. My grandad started feeling ill with his stomach around Summer last year and was constantly going to the doctors who didn't want to know him really, they just fobbed him off, changed his medication and he was gradually getting worse as time went on. It wasn't until Summer this year that just by chance, he for a temporary doctor who sent him for a scan, that they discovered he has pancreatic cancer.

They gave him five years to live, and then discovered another tumour and gave him less than a year, this was two months ago. They haven't even tried anything to cure him, they just dismissed him straight away. Had the doctors have helped him last year, he might be in a better place right now. But the cancer has quickly spread in the last two months, and a nurse told my grandma a few days ago we're looking at a few weeks before his body is just going to shut down and he'll pass away.

Obviously this is a very upsetting time for me and my family, but I think I'm feeling more anger towards the way the NHS haven't even tried to treat him, and how much the doctors have just sent him on his way for over a year. Seeing him laid in hospital today has hit us all. He got whisked away in an ambulance last night and when we went to visit him today, he'd had an accident last night where he was trying to get something from under his bed and fell. And none of the nurses cared, all they were bothered about were avoiding getting sued. They didn't care whatsoever about his injuries or treating him. He's really hurt his ribs. It's disgusting!

My mum needs a new knee and is struggling to walk, also has trouble with her hand and nobody wants to help. My grandma also needs a second knee replacement and all they do is cancel her appointments and the appointments she does go to, they don't help. I've been going to the doctors for well over a year about headaches and dizziness and they turn me away. Even have carpel tunnel starting in my hand and I just got told to treat it myself. From seeing people with this before, I only know of operations fixing this. I honestly don't know why we're forced to pay National Insurance if this is the treatment we get! :mad:

This is why I'm considering going private now. For the sake of £20 - £40 per month, if it means I'm going to get help that I need if I need it, I don't mind paying it. I looked up some quotes a few weeks back and a lady phoned me up with two quotes that matched my criteria, she said one of them even comes with private doctors if I start with a problem. But the thing that got to me was that she said that both policies offer cancer treatments worth about £18,000 a go or something, that the NHS can't afford to give anybody.

But I just don't quite understand how it works.

One other thing, say I ended up claiming for something one year, does this mean my premium would shoot up? Or do I pay the same throughout?

ripplyuk

IMO, it's a very good thing to have, if you can afford it.

I share your frustration with the NHS. The problem with private health insurance is that the premiums will increase a lot with age, which makes sense because the older you get the more likely you are to cost them money. But it also can mean that you can no longer afford it just at the point when you need it most. I know people in their 60's paying premiums of hundreds each month. If you make a claim, it's very likely that your renewal quote the next year will be higher. Any emergency treatment will be done on the NHS as there is no other option here.

Btw, £18,000 won't get you far with cancer treatment. Better than nothing of course but it seems low. Are you sure there wasn't another zero?

GwylimT

£18,000 of cancer treatment will get you to the stage of diagnosis and possibly the first round of treatment, but you'll go no further. So the person on the phone got you believing that the NHS don't treat cancer.

You do realise the GPs you see are private, they just bill the NHS and not you, the amount they charge people who choose to pay is rarely more than they get from the NHS.

I had private health care, for actual private health care that covers everything apart from emergency care you are looking at around £450 a month for a young adult without cover for pre-existing conditions. A pre-existing condition is any symptom currently on your medical records. So a stomach ache would exclude loads of things, IBS, Crohns, coeliacs etc.

You'll also find that private policies limit diagnostic tests to £1000 per year, do you have any idea of the costs involved in diagnosing cancer? £1000 wont cover an MRI nevermind a consultant looking at the images!

I was paying £532 per month, on top of this I paid a co-pay of £100 per condition per policy year. This is the sort of price you pay to get everything included.

You're deluded if you think health care can be gained for £40 a month.

How it works

You go to your GP, yes, that person who works for the NHS and if you require a referral you ask to be referred privately.

You then get sent to whoever your policy agrees you can use, but before you are seen your insurance has to agree and inform the hospital of this. Everytime you receive treatment your insurance company needs to pre-authorise it, this can take weeks, especially if it is something considered non-urgent. Private insurance companies follow NICE guidelines on urgency, so it can take 18 weeks to have a joint replacment surgeny approved for example.

lessonlearned

Well I must have been exceptionally fortunate because I have never paid anywhere near £532 per month for cover. And yes I have made claims......

Jlawson... I am sorry to hear about your grandfather but the sad fact is no matter how much money you have pancreatic cancer is usually a terminal diagnosis. Survival rates are very low.

The reason for this is it is notoriously difficult to diagnose and by the time someone becomes symptomatic the damage is usually already done. More often than not by the time a diagnosis is made the cancer is usually well advanced, often it’s reached Stage 3.

If you think that people like David Bowie can die from it, despite his multi millions, access to the best private treatment etc then it makes you realise just how bad the outlook is. It is far harder to treat than say breast or prostrate cancer and the low survival rates are a sad reflection of this.

It’s a bitter pill to swallow I know but I am afraid that’s the current state of play with pancreatic cancer.

Re all those knee and joint problems. I think this is where private medical insurance is worthwhile. Although if your relatives have already been diagnosed and treated then this will be a “pre existing condition”which is unlikely to be covered by a new policy.

But yes, if you can afford cover for yourself and your family then go for it. Shop around and be sure to compare quotes very carefully and be especially sure to read the small print and double check the terms and conditions.

Re rising premiums......they will rise with age of course and just general price increases. Some companies operate a kind of no claim bonus, some will just add a loading to the premium.....much like your car insurance if you make a claim.

System

lessonlearned wrote: »

Well I must have been exceptionally fortunate because I have never paid anywhere near £532 per month for cover. And yes I have made claims......

I agree £532 + £100 does sound excessive and not something the vast majority of people who have private health insurance would be able or even willing to afford. It would be interesting to see what others pay.

lessonlearned

I’m 66 and pay around £55 a month, with Aviva. I have not gone for BUPA hospitals because they made the premiums higher. However, our NHS hospital has an excellent private wing which I have used.

I pay an excess of £100. I offered to increase that but it didn’t make much difference to the premium. I am covered for £500 worth of outpatient fees. Not a lot I admit but it has been enough this year.

I damaged my meniscus this year and my policy has covered the consultant fees and a steroid injection. The mri scan was not considered as an outpatient fee and was covered separately. I can have one more steroid injection this year if necessary and then after that it will be classed as pain relief rather than “treatment” Iyswim. If I wish to continue with further injections then I can pay for those myself. I was quoted £90 for the injection itself plus the consultants fee.

I may or may not need surgery for my knee, it’s a case of wait and see but I have been told it will be covered if required.

I will lose my no claims discount at renewal but that is only to be expected because I have made a claim this year.

I am covered for cancer drugs not available on the NHS.

The next hike in premiums will be when I’m 70, although of course there might be the usual “cost of living” Type rises before then.

I’ll just have to wait and see. If the premiums get too high then I might have to strip out some of the policy benefits to ensure affordability.

Jlawson118

GwylimT wrote: »

£18,000 of cancer treatment will get you to the stage of diagnosis and possibly the first round of treatment, but you'll go no further. So the person on the phone got you believing that the NHS don't treat cancer.

You do realise the GPs you see are private, they just bill the NHS and not you, the amount they charge people who choose to pay is rarely more than they get from the NHS.

I had private health care, for actual private health care that covers everything apart from emergency care you are looking at around £450 a month for a young adult without cover for pre-existing conditions. A pre-existing condition is any symptom currently on your medical records. So a stomach ache would exclude loads of things, IBS, Crohns, coeliacs etc.

You'll also find that private policies limit diagnostic tests to £1000 per year, do you have any idea of the costs involved in diagnosing cancer? £1000 wont cover an MRI nevermind a consultant looking at the images!

I was paying £532 per month, on top of this I paid a co-pay of £100 per condition per policy year. This is the sort of price you pay to get everything included.

You're deluded if you think health care can be gained for £40 a month.

How it works

You go to your GP, yes, that person who works for the NHS and if you require a referral you ask to be referred privately.

You then get sent to whoever your policy agrees you can use, but before you are seen your insurance has to agree and inform the hospital of this. Everytime you receive treatment your insurance company needs to pre-authorise it, this can take weeks, especially if it is something considered non-urgent. Private insurance companies follow NICE guidelines on urgency, so it can take 18 weeks to have a joint replacment surgeny approved for example.

I might have got the cancer treatment figure wrong but she basically just added that I would be eligible for treatment that the NHS cannot provide

Jlawson118

ripplyuk wrote: »

IMO, it's a very good thing to have, if you can afford it.

I share your frustration with the NHS. The problem with private health insurance is that the premiums will increase a lot with age, which makes sense because the older you get the more likely you are to cost them money. But it also can mean that you can no longer afford it just at the point when you need it most. I know people in their 60's paying premiums of hundreds each month. If you make a claim, it's very likely that your renewal quote the next year will be higher. Any emergency treatment will be done on the NHS as there is no other option here.

Btw, £18,000 won't get you far with cancer treatment. Better than nothing of course but it seems low. Are you sure there wasn't another zero?

I may have got the figure wrong, the phone call about my quotes was around a month ago come to think of it, but I've had so much on lately it's slipped my mind for a bit until I visited the doctors on Monday with severe chest pains and he told me it was heartburn :mad: I think I know the difference. I just wish I could see a private GP

Jlawson118

lessonlearned wrote: »

Well I must have been exceptionally fortunate because I have never paid anywhere near £532 per month for cover. And yes I have made claims......

Jlawson... I am sorry to hear about your grandfather but the sad fact is no matter how much money you have pancreatic cancer is usually a terminal diagnosis. Survival rates are very low.

The reason for this is it is notoriously difficult to diagnose and by the time someone becomes symptomatic the damage is usually already done. More often than not by the time a diagnosis is made the cancer is usually well advanced, often it’s reached Stage 3.

If you think that people like David Bowie can die from it, despite his multi millions, access to the best private treatment etc then it makes you realise just how bad the outlook is. It is far harder to treat than say breast or prostrate cancer and the low survival rates are a sad reflection of this.

It’s a bitter pill to swallow I know but I am afraid that’s the current state of play with pancreatic cancer.

Re all those knee and joint problems. I think this is where private medical insurance is worthwhile. Although if your relatives have already been diagnosed and treated then this will be a “pre existing condition”which is unlikely to be covered by a new policy.

But yes, if you can afford cover for yourself and your family then go for it. Shop around and be sure to compare quotes very carefully and be especially sure to read the small print and double check the terms and conditions.

Re rising premiums......they will rise with age of course and just general price increases. Some companies operate a kind of no claim bonus, some will just add a loading to the premium.....much like your car insurance if you make a claim.

At the beginning of his diagnosis I did think to myself that I know this is one of the worst cancers a person can have and takes many years to grow without the person knowing. It's just annoyed me more how the GPs have turned him away for well over a year. It might not have made much of a difference if this is so far advanced but he still shouldn't have been turned away in the first place. And just seeing him in hospital now, the way the nurses are being towards him and just the general lack of care that seems to be there shocks me. My grandad has worked hard all of his life, paid his taxes and national insurance and then this is how he gets treated? It's all of this that makes me wonder if it's worth going private.

I'll definitely shop around though, thank you

theoretica

Jlawson118 wrote: »

I might have got the cancer treatment figure wrong but she basically just added that I would be eligible for treatment that the NHS cannot provide

Remember she was trying to sell you something and read the small print. The importance to you of any particular treatment the NHS does not provide will depend on how likely you are to want it.

Beenie

The cost of cancer care in a private hospital is approx. £55000 for everything - the tests, the chemo, the nursing care, the consultants fees and the use of the room. This assumes the normal 6 treatments spread over 18 weeks.

I had PPP cover during our working lives, and at retirement we checked how much the premiums would cost if we paid them ourselves. Mine, because of pre-history and age were £7000 a year. My husbands were £2000. Mine would go down in theory after remission, but the age factor kicked in and it was still hugely expensive.

What we do now is to put a sum aside each month in case we need hip or knee ops. Major problems are covered by the NHS, but it's the inconvenient things like cataracts and physio that are better, and faster, done privately.