When you have private healthcare and you need to choose a specialist or consultant, it can be very daunting. In the UK there are over 350,000 registered UK doctors and choosing the right professional for your treatment can seem complicated, but there is guidance available to you. Depending on your medical plan’s hospital list, you could have the option to choose your own specialist.
Your choice will depend on your insurer and its benefit levels and hospital list. Importantly, if you are insured, you must pre-authorise your appointment before you see your specialist.
How to choose a specialist when you have private medical insurance?
If you have private medical insurance and are referred by your GP, you may need to choose a specialist or consultant. The specialist or consultant you choose is based on your healthcare provider network. When you receive your GP referral, make sure you call your private medical healthcare provider and obtain authorisation.
Knowing your cover levels will help, as this will affect how many specialist consultations you can have.
For example, if your outpatient amount is:
- £500 – this is approximately two specialist consultations per policy year
- £1,000 – this is approximately four specialist consultations per policy year
- Full outpatient cover means there is no yearly limit for specialist consultations
It should be noted that the higher the out-patient limit, the more expensive your premiums will be.
Will your insurer’s hospital list affect your options?
Your hospital list is a major factor in how you choose a specialist consultant. No matter which provider you choose, they will have a hospital list or access to an online hospital finder.
The referral from your GP needs to be an open referral. When you call to pre-authorise the claim, the handler will give you 2 or 3 options to choose from.
Standard list
Great coverage but often excludes the higher charging London hospitals.
London upgrade
Choosing to include London hospitals will often increase your premium. This is because the costs tend to be higher for treatment in these hospitals.
Consultant Finder for BUPA members
Bupa provides information on hospitals via their Consultant Finder. You can filter this to your BUPA hospital list, location and specific consultant. Alternatively, you can search a speciality, condition or procedure. It will also advise you if the consultant you have found is Fee Assured and, most importantly, if there will be any shortfall in the payment for your treatment. You can still use a consultant that is not fee assured providing they are recognised by Bupa. You will have to pay the difference between the agreed fees and the consultant charges.
Can my GP help me to choose a specialist?
If you have been unwell, been to see your GP, or spoken to your private GP, optician or a medical practitioner and been referred to see a specialist or consultant, yes, they may support you to choose.
Alternatively, you could leave it up to your private medical insurance provider to choose, or you could look around yourself to find a specialist or consultant best suited to your needs.
Where can you find out about medical specialists?
You could hear about a specialist via word of mouth, or via research, or reading reviews. Ask your GP or healthcare provider about their experience and who they recommend, too. It is important you feel comfortable with your consultant. When you feel unwell, you want to find a specialist quickly and ensure they specialise in your condition. Above all, you want to get the best care possible in the quickest time available.
When you have a Guided Option, the claims team will give you a choice of hospitals. Normally, this will be as close as possible to your home address because this makes it easier for you to travel to your appointment.
Which governing body should the consultant be recognised by?
A consultant or specialist should be recognised by The General Medical Council (GMC). You trust in your specialist to be an experienced medical professional and therefore it is crucial you make sure they are medically recognised. Moreover, you want to ensure your specialist has no negative feedback. The GMC website will give you up-to-date information on the registered practitioner you are interested in.
https://www.gmc-uk.org/registration-and-licensing/the-medical-register#searchTheRegister
In the UK, there are currently 372,724 doctors registered with the General Medical Council. The GMC has been set up since the 1800s, when the government passed legislation to set up a single office register of doctors practising in the UK. For a doctor to be accepted with the GMC, they must apply and undertake extensive checks.
Furthermore, you can search your chosen specialist consultant online and see if there are any restrictions on their practice. This can provide you with peace of mind at a stressful time in your life.
Work with a specialist health insurance broker
The Ascend Health team are unable to direct you when you choose a specialist for treatment, but we can help you to navigate the system and ensure you know what is covered on your policy. Before you make your final decision about a consultant it is definitely worth considering the following questions:
- Who is your provider?
- Do you know which specialist you want to see?
- Does your policy cover out-patient and in-patient consultations?
- Is there a specific hospital list?
- Have you received authorisation to go ahead with the specialist consultation?
Finally, if you are thinking about buying a private medical insurance policy, why not speak to an expert? Cost comparison websites can be very confusing, but the team at Ascend Health can talk you through your options clearly and comprehensively, so you can find the right policy, first time. We never charge a fee, giving you expert advice for the lifetime of your policy at no additional cost. Contact us today for more information, by email: enquiries@ascendhealth.co.uk or by telephone: 01245 929129.