Private Medical Insurance (PMI) - does it give access to new/niche treatments?

bluemonday2

Howdy. I understand that all coverage is policy-specific.

However, does anyone have any sense/any evidence as to whether PMI does give access to new/niche treatments before they become widely available on the NHS?

Many thanks in advance.

DullGreyGuy

bluemonday2 said:

Howdy. I understand that all coverage is policy-specific.

However, does anyone have any sense/any evidence as to whether PMI does give access to new/niche treatments before they become widely available on the NHS?

Many thanks in advance.

It can do but it depends... if you look at the Broker FAQ for Bupa they state:

Do you provide cover for cancer drugs that haven’t yet been approved by NICE? 
As long as there is sound clinical evidence to demonstrate benefit, we will fund them

As this is intended for brokers not consumers you should add on top of that that the cost is within the policy limits (brokers will know that will be a condition without being told)

Mark_d

The NHS needs to consider to balance the chance of a treatment being successful, with the cost.  The more you're willing to pay, the more innovative the treatments you can access.

Private medical may help you find an innovative treatment that works for you but then there's a question of how that treatment is funded on an ongoing basis.  In our case it wasn't a problem but I've heard of cases where the NHS won't fund it now and don't know when they will

DullGreyGuy

Mark_d said:

Private medical may help you find an innovative treatment that works for you but then there's a question of how that treatment is funded on an ongoing basis.  In our case it wasn't a problem but I've heard of cases where the NHS won't fund it now and don't know when they will

Somewhat depends on if we are talking chronic or acute conditions... with the later hopefully there is no ongoing treatment and once you're cured thats it. 

Certainly with chronic conditions PMI will only deal with the initial diagnosis or, with some, acute episodes but not the day to day maintenance and so either you have to transfer to the NHS or fund ongoing medication privately. Depending on what the condition is it may be something where once under control more regular NHS approved approaches may be sufficient for maintenance. 

bluemonday2

For the moment I am just considering this question in the round. The MSE article on PMI suggests PMI may give such access and I am just exploring that question work out whether to get PMI given that I recently lost my job and the associated coverage. Greatly appreciate these answers.

DullGreyGuy

bluemonday2 said:

For the moment I am just considering this question in the round. The MSE article on PMI suggests PMI may give such access and I am just exploring that question work out whether to get PMI given that I recently lost my job and the associated coverage. Greatly appreciate these answers.

On what basis was the form employers cover? Some insurers will allow you to "take over" the cover yourself meaning continuous cover and anything that started whilst you were an employee there won't be considered pre-existing. 

I did manage to get Bupa to agree to allow me to takeover my policy when I ceased being an employee but it was a lot of effort as ours had no medical exclusions and whilst its unlikely my medical condition would ever hospitalise me etc its a fairly systemic one and so "related conditions" could be almost anything other than infection or accident. 

TELLIT01

I don't know, but would assume that a policy covering access to new/cutting edge treatment would be far more expensive than a standard policy.  'New/cutting edge' in medicine generally means very expensive.