Using Private Medical Insurance
If you have private medical insurance and you need some help with making a claim, read our guide.
You can choose to use your private health cover to pay for treatment at Sulis Hospital. Making a claim on your health insurance should be straightforward. We’ve put together this brief guide to help you get started.
Three steps to using your private health insurance at Sulis Hospital
Step one – contact your GP
When you speak to your GP, let them know that you have private insurance and you’d like to be referred to Sulis Hospital.
If you know which consultant you’d like to see - let your GP know. They’ll be able to give you a specific referral letter. The letter should include details of the hospital, the consultant, and the recommended treatment.
If you don’t know which consultant you’d like to see - your GP will give you a more general referral letter.
For some treatments, like physiotherapy, your insurer may allow you to self-refer—meaning you won’t need a GP referral letter. Check with your insurer to see which conditions and treatments this applies to.
Step two – contact your insurer
After visiting your GP, you need to call your insurer so they can activate your insurance. Have your referral details ready when you call them, as they will need the information to check the treatment is covered by your policy.
If you find the treatment isn’t covered by your policy but you still want to go private, you may choose to pay for your own healthcare.
If your GP has not referred you to a specific consultant, but you know you want to have treatment at a Sulis Hospital Bath, let your insurer know. They can provide a list of consultants who practice at Sulis Hospital Bath, so you can choose who you see for your treatment.
Step three – contact Sulis Hospital
If your doctor has given you the referral letter - contact our Private Patient Enquiry line on 01761 422288 or email enquiries@sulishospital.com.
If your doctor contacts Sulis directly - we will get in touch with you. This is usually on the same day.
To book your appointment, you’ll need:
- Insurer details (name of insurer and membership number)
- Your pre-authorisation code for your first outpatient appointment
- The name of the consultant you would like to see (don’t worry if you’re not sure, we can recommend a specialist for you)
- Your diary to arrange the best time to book your appointment
Need help?
If at any point during the process, you find it complicated or confusing, our friendly team is available to help. You can call us on 01761 422288 and we will help you get things sorted.
FAQs
Private medical insurance (PMI) is an insurance policy designed to meet some or all of the costs of private medical treatment. Private medical insurance is often referred to as PMI, private health insurance, private health cover and health insurance.
PMI is designed to ensure that if you need medical treatment in the future, you won’t need to worry about NHS waiting lists or for self-funding the costs of your treatment. If you are treated privately, health insurance will pay all or some of your bills.
Health insurance covers many things including hospital scans, surgical procedures, inpatient treatment (staying overnight in a hospital bed) and medicines. However not all costs are covered in every situation, so it’s best to check with your insurer about any exclusions in your policy. For instance, insurers will not usually cover the costs of treating chronic or on-going conditions that you were aware of before you were insured.
There are many different insurance companies who offer various types of insurance cover. These can include specialist policies for over-55s, ones that focus on particular medical conditions or international policies aimed at expatriates living overseas.
By paying an insurance company a regular amount, known as a premium, this prepares you for unexpected healthcare costs in the future. Insurance is designed to cover the costs surrounding unexpected illnesses, including most costs for private treatment.
Important reasons why patients choose to take out private medical insurance include: fast access to treatment, flexibility to choose the consultant you want to see and having the choice of a particular hospital which is convenient for you. There are many other advantages too, so find out more about accessing private treatment without the wait here.
Accessing your private medical insurance provides you with:
- Rapid access to diagnosis and treatment
- Access to the region's most experienced consultants
- Ability to choose when to be seen and treated
Using your private medical insurance helps take the pressure off the NHS whilst offering you peace of mind.
In general, health insurance covers short-term treatment designed to help you recover from illness or injury. Insurance usually only covers conditions that develop after you first took out your policy.
If you are aware of any medical condition you have before taking out insurance, this will not usually be covered by insurance companies. For instance, if you’ve previously had an injury, treatment or medical advice for a condition before taking out insurance, you may not be covered. This is sometimes referred to as a “pre-existing condition”. It’s always best to check directly with your insurer if you’re not sure.
Most medical insurance companies won’t cover treatment costs for chronic or on-going conditions. There will also be a list of “exclusions” to look out for on your policy, which are specific treatments not covered by your insurance. Examples include cosmetic surgery and A&E care.
You should check your policy and contact your insurer if you have any questions.
You will need to gather the following before your appointment (even if you have attended a Sulis Hospital Bath before):
- your policy documentation (usually a booklet or email sent from your provider)
- the name of your insurance company
- your membership or policy number (this is usually listed on documents sent from your insurer)
- your preauthorisation or claim reference number (this confirms that you are eligible for this treatment)
- you may also be asked for your NHS number, so please have this to hand if possible
Participating hospital/registered provider
A registered provider or participating hospital has an agreement with an insurance provider. This means they can be offered as a choice to members with insurance policies. Sulis Hospital Bath are registered providers, which means we’re authorised to see patients with private health insurance. See the section below for a full listing of which insurance companies recognise Sulis Hospital Bath.
Policy
Your insurance policy is a document detailing the terms and conditions of your contract with your health insurance company. This usually details the duration of coverage, your premium amount and any exclusions. Your policy serves as legal evidence of your insurance agreement.
Premium
An insurance premium is the amount of money that you pay for your insurance cover – this is usually paid as a monthly instalment or as a lump sum for the duration of your policy. The amount of coverage that is included for the premium will vary by the type of insurance product among other factors.
Excess
An excess payment is a contribution you are required to pay towards a claim you make on your insurance policy.
The exact process and amount depends on your policy but most insurance companies will ask you to pay for the care that is under your excess amount directly to the healthcare provider.
Pre-authorisation code
You are likely to need pre-authorisation (approval) from your insurer at different stages of your treatment. For example, for an appointment(s), surgical treatment(s), test(s) and scan(s) etc. This is often to check they are medically necessary and covered in your policy. Sometimes this is also referred to as prior authorisation, prior approval or pre-certification. If you need access to a phone to call your insurer to get pre-authorisation for your treatment, test or appointment while you are visiting Sulis Hospital Bath, please ask a member of staff and one can be provided for you.
Depending on your policy, you may have approval from your insurer for just your first outpatient appointment only. Alternatively, this may include approval for any tests or scans your consultant refers you for. You can check your policy document for details or call your insurer to confirm.
Similarly, if you need surgery you will usually have to get additional approval from your insurer before your treatment is booked in. Don’t worry though, your insurance company will be able to talk you through the process and our team are on hand if you have any questions.
Shortfall
A shortfall is the difference between what a consultant charges for your treatment and what your medical insurance company is prepared to pay.
Some insurance companies have adopted a fee assured system or a capped pay-out scheme. This means the insurance companies set the fee for a named procedure or appointment. The price is only covered if the consultant you chose has agreed with the insurance company to work for this set fee. If the consultant you have been referred to, or you have chosen to see, has not agreed to work for the fee(s) the insurance company has set, you will have to pay the difference (known as a shortfall).
What do we mean by “inpatient”, “outpatient” and “day case”?
These three terms are determined by how long you’re staying in hospital for. As an “inpatient” you will stay in hospital overnight while you have your treatment. Your consultant will discuss this with you and let you know how many nights you should expect to stay in hospital.
As an “outpatient” you will simply visit hospital for your appointment and then head home afterwards. When you have your first appointment with a consultant, this is often referred to as an “outpatient appointment”.
“Day case” refers to when you need to stay in hospital following a procedure, but only for a short time during the day. You will then usually be discharged (sent home) on the same day as your procedure. However, sometimes a patient may have come into hospital for their treatment as a “Day case” but for clinical reasons will need to stay overnight, therefore becoming an inpatient. Quite often, your insurance company will need to be notified to approve the unplanned overnight stay.
The private patient terms & conditions form part of a contract between you and Sulis Hospital Bath which consists of your registration form, the private patient terms and conditions, and your treatment letter. A copy of the current private patient terms and conditions will be sent to you with your treatment letter and further copies are available at the hospital.
The organisation conducts Data Privacy Impact Assessments for all high-risk personal data processing. These may be available on request by contacting us at DPO@sulishospital.com. Please note that some information may be redacted where it is corporately sensitive.
Read Sulis Hospital Bath’s privacy notice for private patients.
We work with all major private healthcare providers in the UK. Here’s a list of those we work with most frequently.
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