Self-pay vs health insurance

There’s more than one way to access private healthcare in the UK. You could use private medical insurance if you have it or choose to self-pay. In some circumstances, you can even combine the two. Here’s our guide to self-pay treatment vs health insurance so you can consider your options.

How does private health insurance work?

Private health insurance allows you to access private healthcare, and your health insurer pays the costs. When you take out a health insurance policy, you’ll receive core coverage as standard, and you can also add optional extras to make your coverage more comprehensive. You might opt for individual health insurance or add your partner or children to provide private health insurance to the whole family.

You pay an annual or monthly premium and contact your insurance provider to make a claim when you need to access private healthcare.

Find health insurance: Read our guide to the best health insurance providers in the UK.

What does health insurance cover as standard?

Health insurance policies vary between providers, but most private health insurance covers day patient and inpatient treatment, cancer care and some form of mental health support. So, if you need to be admitted to a hospital for surgery, your health insurance policy will pay for it.

You’ll also have access to private support services, such as a virtual or digital GP that offers appointments 24/7, telephone helplines, and online resources providing health advice.

What are some of the optional extras?

You can tailor your private health insurance policy to include a broader range of treatments and services. Outpatient coverage offers many of the main benefits of private health insurance, including consultant appointments, diagnostic tests and outpatient treatments such as physiotherapy. Other optional extras include cover for therapies and additional mental health treatment.

If you want to improve your core coverage, you can also add extra treatment sessions or increase the financial limits on different types of treatment.

What isn’t covered?

Every health insurance policy has exclusions, meaning you won’t have access to private healthcare for certain conditions. These typically include treatments for addiction, cosmetic surgery and normal pregnancy and birth. Private hospitals also don’t offer emergency treatment, so they aren’t an alternative to A&E if you have a life-threatening condition. There are other circumstances where your private medical insurance won’t pay the cost of your care.

Chronic conditions

Chronic conditions are illnesses that your doctors can’t cure with a single course of treatment and need long-term management and monitoring. Chronic illnesses include conditions such as high blood pressure, diabetes and angina.

Private healthcare only treats short-term acute conditions, so you’ll need to stick with the NHS if you have a chronic illness.

Pre-existing medical conditions

Private health insurance doesn’t cover pre-existing conditions. These are any conditions you sought medical advice or treatment for in the five years before you took out your private medical insurance. Depending on the type of underwriting you have with your policy, your insurers may ask you to provide details of your medical history when you sign up for your private health insurance. Alternatively, your insurers may investigate to ensure the treatment you need is covered when you claim.

Pre-existing medical conditions are excluded for the first two years of your policy and can be added on after this if you’ve stayed symptom-free. For example, if you had physiotherapy for knee pain before you had private health insurance, you won’t be covered for knee surgery in the first two years of the policy.

Read our guide to why health insurance doesn’t cover pre-existing medical conditions.

How does self-pay care work?

Self-pay options allow you to pay for your treatment without paying for private health insurance cover. You can choose a private hospital and a specific consultant specialising in the treatment you need and pay your treatment costs directly. There are various ways to access self-funded treatment. You may want to pay for your initial consultation and diagnostic tests or for all of your surgery costs.

How to work with a private healthcare provider

Choosing to fund your own private healthcare allows you to do your research to find a private hospital that suits your needs. Most private healthcare providers have details of their self-pay process on their websites. You’ll often be able to contact them online or by telephone to ask questions or book an appointment. Some ask for a GP referral letter to ensure the consultant you want to see has the right expertise to treat you. You may also be able to book a private GP appointment online to speed up the process.

Your chosen provider will then give you a quote for the treatment you need. You’ll typically need to pay for your initial consultation straight away. Most providers also offer flexible payment plans to allow you to spread the cost of your treatment.

What’s included in self-pay treatment costs?

The quote you receive from your healthcare provider will detail all the elements included in your treatment. A quote for surgery will likely include your initial consultation (unless you’ve paid for that separately), pre-operative checks and some post-operative rehabilitation. It’ll also include the cost of private surgery, for example, your surgeon, the anaesthetist and the nursing staff, and a private room while you’re in the hospital.

If you get more than one quote, it’s vital to check what’s covered to make the most of your budget.

When might I want to choose self-pay treatment?

Self-pay treatment offers an alternative to private health insurance and NHS treatment. If you want to access healthcare quickly and are facing a long wait for NHS treatment, self-pay can offer an excellent alternative if you have the funds available. Here are a few of the main reasons why self-pay could be the right choice.

Your treatment is low-cost

The cost of private surgery varies depending on what you need. Some procedures, such as cataract surgery, a tonsillectomy or a colonoscopy, cost in the region of £1,500 to £2,775. Others cost a lot more, with knee surgery or a hip replacement costing in the region of £12,000 to £13,000. However, if you have the means, you may consider it worth the cost if it helps you regain your quality of life.

Your views on what represents a low-cost treatment will depend on your circumstances and how much you have tucked away in savings.

You want a quick diagnosis

If you want to see a consultant quickly or have diagnostic scans and tests privately, these will typically cost a few hundred pounds. The cost could be well worth it if it helps you to spend less time on an NHS waiting list.

Even if you can’t stretch to private treatment, this could help you to get the care you need more quickly.

You don’t already have health insurance

If you’ve seen your GP and received a referral to a consultant, private health insurance won’t cover your treatment as your insurer will class it as a pre-existing condition. That means you’ll need to wait for NHS treatment or fund your own private healthcare.

Your health insurance doesn’t cover your treatment

You may already have private health insurance but find that it doesn’t cover your treatment, either because you don’t have the right level of coverage or because of an exclusion on your policy. For example, you might have chosen private medical insurance to cover inpatient treatment and surgery or private treatment if you’re diagnosed with cancer but found that outpatient coverage took the cost of your medical insurance beyond your budget.

If you don’t have outpatient coverage, you won’t be able to get a private diagnosis, but you can get a referral from your GP for private healthcare after being diagnosed via the NHS.

Are there any circumstances when self-pay treatment isn’t a good idea?

Sometimes, paying your private healthcare costs yourself isn’t a viable option because you don’t have the funds available. Payment plans and medical loans can help, but you’ll need to either meet the loan company’s criteria or be confident that you can meet the monthly cost of a payment plan.

While most private hospitals offer fixed-price packages for surgery, other types of medical treatment are less predictable. If you don’t already have private medical insurance, cancer treatment could cost hundreds of thousands of pounds, depending upon your needs.

Can I choose where I’m treated and which consultant I see?

Paying for private medical care gives you total control over which consultant treats you and the hospital you go to. This lets you choose your consultant and hospital based on criteria you determine, for example, the consultant’s experience and expertise, being treated close to home or the hospital’s facilities and services.

How much does private treatment cost?

The costs of private treatment vary depending on many factors. The price depends on the type of treatment you need and the healthcare provider and hospital you choose.

Location can be a significant factor, influencing everything from staff wages to rents and utility bills. Some providers have relationships with NHS hospitals or offer their own hospitals with hotel-style facilities. If you’ve already seen an NHS consultant, you may be able to have private treatment with them in a private room at the same hospital.

How much does health insurance cost?

The cost of private health insurance is based on various factors that health insurers use to assess the risk you’ll claim against the policy. These include your personal circumstances, for example, where you live, how old you are and the type of work you do. The older you are, the more your insurance will cost. Equally, if you work in construction, there’s a much higher risk of being involved in an accident than if you sit at a desk all day.

The level of coverage your policy provides also has a significant impact on cost. Sticking to core coverage is cheaper than adding optional extras such as outpatient coverage.

Get professional advice

We hope you’ve found this guide useful. If we’ve got you thinking about your private healthcare options and whether you need private health insurance, we’d recommend contacting a specialist health insurance broker for advice.

As we’ve already mentioned, health insurance can include many different options, services and levels of coverage. Different providers also offer various services and benefits depending on your needs and preferences.

A broker can help you compare quotes and understand your options to make an informed choice. They can also help you to find the best possible coverage for your budget by considering elements such as a policy excess, guaranteed renewal prices or community-rated schemes where individual claims don’t affect your premium.

At myTribe, our guides are created to offer information that will help you consider the right health insurance for your needs. Contact us, and we’ll connect you with a highly-rated broker authorised and regulated by the Financial Conduct Authority and offering you personalised advice and a comparison quote tailored to you.

Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.