Out-patient cover; what does it mean?

When you buy a private medical insurance policy, there will be multiple options and different insurers, different policies and different geographical areas to choose from. One of the benefits available to you is out-patient cover, but you may not be entirely sure what this means.

Out-patients cover can be split into two sections: consultations and diagnostics. When your GP refers you to see a specialist, this is normally done as an out-patient consultation. If your specialist requires you to have tests, these are generally done as out-patient diagnostics. These are the two different elements of out-patient cover.

Out-patient cover for consultations

Private medical insurance policies offer different levels of out-patient cover. You can choose full refund, reduced cover or zero cover for consultations. If you opt for full cover, this will be a more expensive policy. Full cover will pay for all eligible consultations. Please remember that you need to obtain pre-authorisation from your insurer before you see your specialist. Importantly, the claims team will check that your condition is eligible for cover and that the consultant is recognised and fee assured

Out-patient cover for diagnostic testing

You can choose to include full cover for diagnostic tests. This means that things like X-rays and blood tests are covered in full. Surprisingly, blood tests can be very expensive, therefore if you include diagnostic tests in your overall out-patient limit, you may end up having to self-fund an element of your diagnostic testing. High-cost scans such as MRI, PET and CT scans are often included in the core cover of a policy.

Essentially, when you are treated as an out-patient, you do not stay in hospital overnight and are not required to remain in hospital for a whole day.

How do you know if your procedure is done as an out-patient?

Every medical procedure has a reference code. As an example, a colonoscopy has a procedure code of H2002 and is usually done as an out-patient. A colonoscopy takes about 30 – 45 minutes to complete and it is unlikely you would need to remain in hospital. Even if you receive sedation for your colonoscopy, you will not be required to remain in hospital unless there are un-expected complications. A colonoscopy is a diagnostic test used to investigate colon issues. When you have the test done, your consultant may find conditions such as polyps, diverticulitis, colitis or even bowel cancer.

Ask your specialist whether your procedure will be done as an out-patient and get the associated code. This will make it easy for you when you ring your insurer for pre-authorisation. If you do not have out-patient cover on your policy, you can self-fund or wait for your treatment on the NHS.

What types of out-patient cover is available on UK private medical insurance?

Your insurance provider will offer you different out-patient cover levels. The most expensive option is full refund. The cheapest option is zero out-patient cover.

Flexibility is the key here because insurers know there is not a one-size-fits-all approach.

Depending on your insurance provider, you will be also able to choose from:

  • £500, £750, £1000, £1250 and £1500 out-patient consultations
  • Out-patient diagnostics included in your out-patient limit or full refund diagnostics
  • Up to two consultations and unlimited diagnostics
  • Up to four consultations and unlimited diagnostics

To clarify, if a client chooses £500 outpatient consultations (visits to a specialist) with full refund for diagnostic testing such as blood tests and x-rays, this would cost more than if they choose to have £500 out-patient cover that includes both consultations and diagnostic testing.

Out-patient cover limits and cancer treatment on your private medical insurance

Having a low out-patient cover limit will reduce your premiums. You will be pleased to know that if you are diagnosed with cancer, however, insurers generally do not apply a reduced out-patient limit for cancer claims. This is important and will give you additional peace of mind. No-one wants to worry about the claiming process especially when it comes to cancer treatment.

Medical treatments that can be done as an out-patient:

In short, there are a number of procedures completed as an out-patient. Out-patient treatment is generally cheaper that day-patient/in-patient treatment because you will not have to stay in a hospital bed or have any type of complicated medical surgery.

  • Endoscopy
  • Colonoscopy
  • Biopsy
  • Physiotherapy
  • Counselling
  • Radiotherapy and chemotherapy

The above list is certainly not exhaustive because there are many procedures completed under out-patient cover.

When you buy your private medical insurance, it doesn’t have to be complicated. Choose an experienced health insurance broker who can explain your options in layman’s terms. You want a policy that works for you, and it is important to understand the cover that you buy. The experts at Ascend Health are waiting to help. You can contact us by telephone or email, whichever is easiest for you. There is no call centre and definitely no multiple dial options to navigate. We want to help you to buy the right policy, first time.

So, please don’t leave your cover to chance! Let us give you the information you need to make an informed decision.

Contact us today on 01245 929129 or email enquiries@ascendhealth.co.uk