private health insurance help Post Reply

[lilasinlondon]

Hello everyone,
I am quite new to the UK health system and I have to admit that I still quite not understand it. I have private health insurance through my husband's work. I wanted to go see the paediatrician with my son who has been sick (already went to the GP), but apparently I need a referral from the GP. Is it possible to go to a private paediatrician and pay myself? And if further treatment is needed, and that the paediatrician gives me a referral for further exams (such as blood work or scan), will that be covered by my insurance?
lilas

[broodje]

You can pay for pediatrician by yourself, but further referrals won't be covered by insurance.

Why not just get GP to refer you to pediatrician? I know some of the NHS GPs are reluctant to refer to specialists, but they are less reluctant if you tell them you have private insurance and are insistent.

Finally, if you find no joy with your NHS GP, just go to private GP and they will refer you and that referral is just as good for insurance company - as long as GP is GMC registered it doesn't matter whether it's an NHS or private GP.

Richmond Practice is good. I think Thurleigh Road Practice also has private patients, but haven't tried them personally.

[lilasinlondon]

Hello Broodje,
to go to a private GP, do I have to register with them or can I go just for the referral?

[broodje]

It depends on GP, you would need to register in any case, i.e. fill out a form, etc. But you don't have to pay for membership, you can just pay for a one off consultation.

[lilasinlondon]

Another question; can the referral be general or does it need to have the name of a paediatrician on it?
Lilas

[Geegee007]

Hello,
I hope your child is ok. I have used two different insurance companies (BUPA and PPP) and their processes were slightly different and varied too depending on the treatment I required.
For example for physio, the insurance co. just required my GP to have a record that I had seen them and that the best course of treatment for my condition was physio, no letter, no names. I then called the insurance company to inform them, obtained approval to proceed with a physio registered with them and started treatment. However, when I have required scans, surgery, etc, an actual written referral and assessment was required. NHS doctors charge for this but you shouldn't have a problem obtaining it. Once you have it, then call for approval.
In terms of a named consultant, if you have no personal recommendations and your GP is unwilling to help then I suggest asking the insurance company for guidance/suggestions on those specialists available at your local hospitals, then perhaps you could undertake a bit of internet research before deciding who to go with.

Either way I would call the insurance company and ask them to talk you through exactly what is required for you to claim.

As the PP said, if you GP is not obliging most private doctors with write you a referral for a fee.

[supergirl]

In my experience with BUPA the process vary between children and adults.

Even though i have written referrals for my children they ce never asked for it, but they ve been registered from birth.
As an adult, i always have to email them my referral for approval. I dont need to be assess anymore as we ve been with them for 8 years.

Your GP should not be reluctant to give you one but he/she may sound condescending though. I ve experienced that but dont take it personnally (a GP failed to diagnose a pneumonia in my 8 months old but gave me a referral in a very patronising manner, we ve put a formal complaint agsinst that GP).

Many times i didnt have any names. The GP would then give me an open letter and i would then do my own research.
But check your policy, some have restrictions when it comes to where you can go.

Most insurers would be happy to help. Call them to ask for the process. It is the best way.

Good luck.