Level of cover

Not all private medical insurance policies are as comprehensive as each other, and they're often graded by price. 

The most important thing is to check the contract terms before making a commitment to ensure you're getting the right coverage for your needs. 

If, at a later stage, you have a problem with the level of cover that your policy offers, revisit your contract and check the details. 

You'll only be entitled to the cover stated in your contract.

Checklist

  • Ensure you inform your provider of all pre-existing medical conditions.
  • Always read the contract before making a commitment to ensure the cover meets your needs.
  • If you're unhappy with your cover or with a service, complain to your provider in the first instance.

Common exclusions 

A common issue for policy holders is pre-existing conditions. When you take out a policy, you will be required to detail all pre-existing medical conditions and your provider may not cover you for illnesses relating to these. 

Another common restriction is around treatment choices. Policies may only cover treatment from selected specialists, or surgical procedures and treatment considered to be 'proven', as opposed to 'experimental'.

If you disagree with your policy provider's decision and feel their exclusions were not made clear to you, complain to your insurer

Should they be unable to solve your problem, the Financial Ombudsman Service (FOS) can review your case, and act if a service or administrative error has occurred. 

If the insurance provider has failed to provide all that has been laid out in your contract, or if you feel the contract exclusions were not made clear to you, then your provider could be held in breach of contract and you may be able to challenge them.

Unhappy with a service

When you buy private healthcare you're paying for a service, in the same way you'd pay for a service from a plumber or builder. 

As such, under the Consumer Rights Act, the care your insurer arranges should be provided with reasonable care and skill. 

For example, if a policy provider has stipulated that you use a certain specialist and the treatment they provide is poor, your policy provider may be partially at fault for this. 

In this case, you have the right to make a complaint to both your insurer and the medical practitioner. 

Pursuing a claim or complaint 

By way of resolution you may be offered a free corrective treatment, or a refund. 

But before accepting any resolution from your practitioner, consider whether you intend to pursue a personal injury claim, for example for pain and suffering, time off work or other expenses accrued as a result of your injury. 

If you intend to do this, be sure to seek specialist legal advice. 

If you need corrective treatment but have lost confidence in your practitioner, you must seek legal and medical advice before seeking treatment elsewhere. 

This is important if you're intending to claim for personal injury so that you have a full understanding of the extent of the damage from a reliable source. 

You may also wish to report the practitioner to the General Medical Council, if you feel they are no longer fit to practice.

Make sure you've taken legal advice on all aspects of your case before agreeing to any settlement of your claim. 

Suspicion of professional misconduct

If you’re unwell and seeking treatment, the improper behaviour of a medical professional can make the experience much worse.

If a medical professional seeks an improper relationship, makes unsolicited visits, breaches your confidentiality, appears to canvas for business or simply displays bad manners, alarm bells should ring.

Notify the practice manager immediately, and follow the formal complaints procedure if necessary.

If your issue is not resolved you can report the practitioner to the General Medical Council

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