What is guided consultants in health insurance?

Private medical insurance enables you to access private treatment quickly and conveniently. Your choice of consultant and hospital will depend on the coverage your health insurance policy offers. In this guide, we explain how a guided consultant list works so you can make an informed choice about your options.

How does consultant choice work?

Whether you have private healthcare via your health insurance or opt to have NHS treatment, you’ll usually be able to choose the consultant who treats you. Your health insurance provider will let you know which consultants your health insurance policy covers. Each health insurance plan also has a hospital list detailing which private hospitals are covered by your insurance. Your insurer will let you know which hospital list your policy includes.

Unrestricted access or a smaller pool

There are a couple of different ways that you can choose your consultant. Your policy may give you free choice or offer a guided consultants option. Your preference will affect the cost of your health insurance policy and the level of consultant choice. If you have a free choice of consultant, you can tell your insurer who you’d prefer to see. We’ll explain more about how guided consultant choice works shortly. Health insurers typically choose guided consultants who are experts in their field and who can also keep their costs within the financial limits set by your insurer.

How much does it cost to see a private consultant in the UK? Our research into prices in 2023.

How does guided consultant choice work?

To access private healthcare with a guided consultant list, you’ll usually need to see your GP first and ask them to provide an open referral. Next, you can contact your private medical insurance provider to start the claims process.

Choose from a shortlist of hospitals and consultants

When you opt for a guided consultant choice, your insurance providers will offer you a shortlist of private hospitals and consultants when you contact them to start your claim. They’ll ensure that the suggested consultants deal with your illness or condition and have speciality training in that area. The number of consultants on the list your insurers offer you varies between insurance providers. Some offer a choice of several hospitals and then let you know which consultants are available when you’ve chosen your preferred hospital. Others will simply offer two or three consultants for you to choose from. You can book your initial appointment or treatment date when you’ve made your choice.

What are the benefits of guided consultants?

A guided consultants list could be the right choice if you’re happy to take your health insurance provider’s advice about who treats you. Here are the two main benefits of including a guided consultant option in your private medical insurance plan.

1. You can lower your health insurance premiums

Health insurance companies offer many ways for you to tailor your coverage and ensure that the cost of your health insurance stays within your budget. You can opt to have core coverage without any optional extras or include a policy excess or a 6-week wait option in your policy. Our research found that health insurance policies with a guided consultant option are typically 20% cheaper than those with unrestricted access, so choosing this helps you save money on your premiums.

You can see our research into the average cost of health insurance here.

2. Afford more comprehensive cover

If you have a limited budget, opting for a guided consultant choice could allow you more comprehensive coverage. For example, you may be able to add outpatient cover to your policy. Outpatient care offers some of the best health insurance benefits. For instance, it pays for consultant appointments and diagnostic tests to give you a private diagnosis rather than waiting for an NHS diagnosis. All health insurance covers inpatient treatment, such as surgery. However, outpatient cover can also pay for your treatment sessions if you don’t need surgery but would benefit from physiotherapy.

3. A guided consultant list makes it easier to choose a consultant

You’ll likely want unrestricted access if you have strong views about which consultant you wish to see or your preferred private hospitals. However, if you just want to access treatment quickly and don’t mind who you see, guided consultant choice can help. Your insurance company will do the work to narrow down the choice for you based on the amount the treatment costs. Your insurers will then provide you with a short list of names to choose from. The list will include consultants who offer the treatment you need at a local hospital. Ideally, you’ll have had advice on the right hospital list before choosing your policy so you’ll know that your health insurance plan includes hospitals near your home or workplace.

Your health insurance company can still offer advice to help you to narrow down your choice of a consultant if you ask them to. They’ll have information about individual consultants based on feedback from previous customers. You can also research to see which one you’d prefer, but generally, the choice is quicker and easier.

What are the benefits of unrestricted consultant access?

Unrestricted consultant choice allows you to choose your consultant based on your needs. Seeing the best consultant in their field may be a priority for you. Factors such as the hospital’s location and facilities can also affect your preference. Many insurers have a network of private hospitals across the country, so you can receive treatment close to home or go further afield to make it easier for your family to visit you while in the hospital.

A guided consultant list typically includes financial treatment limits. This may not cover the costs of the most highly experienced consultants, particularly if they offer treatment at hospitals in Central London, where treatment costs are higher. British Medical Association guidance suggests unrestricted access should be preferred wherever possible. If your policy offers a free choice of consultants, this will improve your chances of seeing your preferred expert.

1. Greater flexibility

Unrestricted consultant access lets you choose your preferred treatment provider. Whilst a wider choice of consultants can mean that you spend more time doing research, this may not always be the case. Of course, you may value the opportunity to investigate your options thoroughly before making your choice.

2. Access to a wider range of treatments

There are various reasons why you might want to see a particular consultant. You may have had an initial appointment with an NHS consultant and want to ensure you see them for your private treatment too. Equally, your doctor may have recommended treatment that requires specialist medical education and is only available privately or with specific consultants. Private health insurance often provides access to new treatments that aren’t currently available on the NHS. Free consultant choice may be essential if you need treatment from a surgeon with experience or training in a particular cutting-edge procedure.

3. Go with a personal recommendation

Alternatively, if you’ve done your research, you may have a preferred consultant based on third-party reviews or your knowledge of their success rates with a particular procedure. You may even have had a personal recommendation from family members or friends based on their treatment sessions and the overall experience.

4. More choice of treatment location

A free consultant choice can also allow you to have your treatment at a more convenient location. Various factors influence your health insurance cost, including your personal characteristics and medical history and the hospital’s location. If you want to ensure that you receive treatment close to your home or workplace, you may need a hospital with a city centre location. Private hospitals in cities tend to have higher costs, which can exclude their consultants from guided choice lists, meaning you must travel further afield. While you may be willing to travel for surgery, attending pre-operative assessments or follow-up checks could be more costly or inconvenient.

5. Shorter waiting times

Health insurance provides quick access to private healthcare so you can return to living your life. As patients face long NHS waiting times for elective treatment, fast access to health care is one of the most significant health insurance benefits.

Your private medical insurance can ensure you’ll receive treatment more quickly. However, your choice of consultant can also influence how long you wait for private treatment. Free choice can allow you to opt for a consultant with excellent expertise but whose fees put them outside the cost guidelines required for inclusion on a guided consultants list. As a result, they may have a shorter waiting list than other specialists who charge less. Whilst you might spend longer researching different consultants and hospitals before choosing, your health insurance will still allow you to access treatment quickly.

Your health insurance provider can also be a good source of information and guidance if you’ve narrowed your options but would like some support to make your final choice.

Get professional advice

Deciding whether to opt for a guided consultants list or unlimited access to the consultants of your choice can involve considering many factors. Your budget and the health insurance coverage you need will heavily influence your choice. Equally, you can tailor your coverage with your choice of hospital list and how much choice you want to have over the consultant who treats you.

A specialist health insurance broker can help you to understand and navigate your health insurance options and find the right policy for your needs. At myTribe, we provide guides to help you understand private health insurance and make an informed choice. When you contact us for a comparison quote, we’ll put you in touch with a highly-rated broker who’ll provide tailored advice to guide you through your options.

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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.