Does Private Medical Insurance (PMI) cover private GPs fees?

In the UK medical insurance is provides the reassurance that if you need specialist care, you will be covered.  And you will be required to see a GP to be referred for any specialist care that you need.  Until recently there was little, or no GP cover included in PMI offering.  But with the disruption to GP services during the pandemic most insurers realised that they needed to offer their own GP offering to provide a route to the referrals as the NHS GPs were no longer able to provide these.  There are often exclusions to what this typ eof GP service will cover – and it is largely delivered remotely.

So, if you set yourself up as a private GP are there any patients who come to see you whose invoices will be covered by an insurer? Here are a few scenarios where your invoices may be covered:

• A few UK PMI providers allow patients to access private GP delivered by providers of their choice.  You just see the GP,submit a receipt and they will re-imburse you. But there will only be a limited amount of cover – £300 to £500
• Some Global PMI policies will cover private GP invoices in the UK

• Overseas patients who normally have private GP cover in their home country will sometimes be able to use their insurance in the UK.  Many German, Swiss and American polices work like this.  A detailed receipt with a diagnosis is normally all that the patient needs. Once submitted, patients will be reimbursed directly.
• People with travel insurance usually have some provision for private GP fees.

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Are lab tests, ecgs and radiology that you order usually covered by PMI?

If someone is planning to use PMI both you, and the patient, need to understand what is, and is not covered before you run up bills on the patient’s behalf.  Private pathology and radiology is more expensive than many people imagine.  We’ve noticed that one quirk of the UK private insurance offering is that imaging is usually only covered if ordered by a specialist.  So you see someone with a painful shoulder but in order to get an ultrasound done you have to refer to a orthopaedic specialist first.

Does all this make our job easier or more difficult?

Hard to say – nice not to have to worry about the financial burden of your services and tests, but on the other hand if the patient is self-funding, you need to be very sure that any service you offer is really good, and any tests you do are carefully considered and necessary, and any referrals you make are appropriate and to people who are skilled and agreeable. Transparency about costs is essential and involves good communication with your patient.  And you hope that this all helps to build trust and confidence in you as a GP and we all know how important that is in the context of delivering a good primary care service.  

And how do you let people know that if they wish to use private GP services using their PMI (if they can).

Check out the ‘Find a Private GP’ tab on the new Private GP Forum Resource and make sure that you are listed.

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(At the time of writing we gather that since pandemic a lot of insurers will include some levelof private GP.  Digital mostly.

Vitality limited f2f selection of private GPs (less than 40 for we think – so there are long waitsand a co-pay and limit to how many times you can access)

F2F with Axa and Freedomand probably Bupa Global – up to £300 and all will include video to GPs throughthe App AXA up to £500

Bupa use Babylon for their private GP resource)

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