Private healthcare when exceeding insurance limit

Cairnpapple

I have private medical insurance through my work which has a £2000 limit for consultations and tests. My consultant has been very thorough about tests, which means that I am nearly at the £2000 limit already. I'm expecting I will need more appointments and tests before the plan year renews on 1 August. 

I haven't ever gone over the limit before so I called to check how it works. The insurance company has advised that they will still get the invoices but will then ask me to pay the amount of the invoices directly to the hospital once I have exceeded the limit. 

I am happy to pay for continuing appointments and tests but I don't want to pay more than I have to. 

1. Does anyone know if there is ever a difference between the price paid through insurance and the price paid via self-pay? I know that my physio charges the same for each, but I don't have visibility for other services and I don't know who to ask (I asked when I was rescheduling a consultant appointment but they couldn't tell me).

2. Any other ways to possibly reduce or spread out the price? I'm getting some additional blood tests done through my GP so I don't have to pay for those, and I'm in Scotland so prescriptions are free if I get them through the GP. My outstanding issues are more chronic than acute, so I will try to space out the appointments a bit. I do know that if/when I end up going for a colonoscopy it counts as a procedure rather than a test so it should be covered from a different pot that isn't subject to the £2000 limit (thankfully! they're not cheap!)

Just had the thought that a cashback card with a good initial offer would at least get me a few pennies

Any thoughts would be welcome!

flaneurs_lobster

Not going to comment on how you should time your medical treatment schedule to fit in with the financial year....

I managed to time some expensive dental treatment with a new card offer from Amex, got £150 in cashback.

Amex and other deals are detailed elsewhere on this site, not seeing anything over-generous unless you want to look at the Gold/Platinum cards.

MyRealNameToo

Cairnpapple said:

1. Does anyone know if there is ever a difference between the price paid through insurance and the price paid via self-pay? I know that my physio charges the same for each, but I don't have visibility for other services and I don't know who to ask (I asked when I was rescheduling a consultant appointment but they couldn't tell me).

2. Any other ways to possibly reduce or spread out the price? I'm getting some additional blood tests done through my GP so I don't have to pay for those, and I'm in Scotland so prescriptions are free if I get them through the GP. My outstanding issues are more chronic than acute, so I will try to space out the appointments a bit. I do know that if/when I end up going for a colonoscopy it counts as a procedure rather than a test so it should be covered from a different pot that isn't subject to the £2000 limit (thankfully! they're not cheap!)

Never done any analysis on it but I know when the Mrs was treated as a day patient at a private hospital the invoices our insurers showed they'd paid were notably more than the price shown on the hospitals website however I didnt have sight of the actual invoices just the total paid and there is potentially other costs legitimately added which arent considered in the price list. For example there were two ward rounds a day and a consultants appointment at least every other day, the hospital price list wasnt clear if these were included or not in the price they showed. 

Whilst you would expect an insurer to get discounts these can work in different ways, sometimes its an upfront discount so they simply pay less in other cases they may pay list price initially and then receive a rebate depending on volumes spent in the year afterwards. 

Some hospitals do offer finance, Spire for example give 0% interest if repaid in under a year but potentially they're charging more from the get go and so having a non-financed option from another hospital like HCA may be cheaper. 

Murphybear

Cairnpapple said:

I have private medical insurance through my work which has a £2000 limit for consultations and tests. My consultant has been very thorough about tests, which means that I am nearly at the £2000 limit already. I'm expecting I will need more appointments and tests before the plan year renews on 1 August. 

I haven't ever gone over the limit before so I called to check how it works. The insurance company has advised that they will still get the invoices but will then ask me to pay the amount of the invoices directly to the hospital once I have exceeded the limit. 

I am happy to pay for continuing appointments and tests but I don't want to pay more than I have to. 

1. Does anyone know if there is ever a difference between the price paid through insurance and the price paid via self-pay? I know that my physio charges the same for each, but I don't have visibility for other services and I don't know who to ask (I asked when I was rescheduling a consultant appointment but they couldn't tell me).

2. Any other ways to possibly reduce or spread out the price? I'm getting some additional blood tests done through my GP so I don't have to pay for those, and I'm in Scotland so prescriptions are free if I get them through the GP. My outstanding issues are more chronic than acute, so I will try to space out the appointments a bit. I do know that if/when I end up going for a colonoscopy it counts as a procedure rather than a test so it should be covered from a different pot that isn't subject to the £2000 limit (thankfully! they're not cheap!)

Just had the thought that a cashback card with a good initial offer would at least get me a few pennies

Any thoughts would be welcome!

A colonoscopy can be either a procedure or a test

Why it's a Test:

• Visual Inspection: Allows a doctor to directly view the entire lining of the colon for abnormalities.
• Diagnosis: Helps find the cause of symptoms like bleeding, pain, or changes in bowel habits, and diagnose conditions like polyps, inflammation, or cancer. 

Why it's a Procedure:

• Intervention: Doctors can remove polyps (growths) or take tissue samples (biopsies) during the exam.
• Treatment: Removing polyps prevents them from potentially turning into cancer, making it a preventative treatment. 

Dizzy_Ditzy

Each insurance company has a different maximum that they’ll pay a consultant. Example - AXA will pay max of £200 for a consultation whereas BUPA will only pay £130

OP you have the option of self pay or waiting until the new FY