Can patients pay for private GP appointments with insurance?

Understanding Insurance Coverage for Private GP Appointments

If you're considering becoming a private GP, one of the key questions you'll encounter is whether patients can pay for private GP appointments with insurance. Understanding this can make a significant difference in managing your practice efficiently and ensuring your patients receive the care they need without unnecessary complications.

What private GP services are covered?

All private healthcare policies are different, and it is crucial that your patient understands what is and isn’t covered in their policy. Not all services are covered, so your patient needs to know if their policy covers:

• Virtual or face to face appointments
• Referrals to specialists
• Any additional tests or treatments

What if the patient is unable to pay upfront and claim back?

If the patient cannot pay for their appointment upfront and claim back with their insurance, they will need to arrange for a ‘Guarantee of Payment’ (GOP) to be sent. A GOP confirms that the patient's insurer will pay for the fees incurred. Having a GOP before the appointment is crucial. Add it to the patient's record to assist with any payment follow-ups with the insurer. The GOP will outline any restrictions, like exclusions for medical reports or contraception.

"It can be difficult to claim back payments from insurance companies for your patients. Ideally, patients should pay upfront and claim back from their insurance. This ensures you are paid promptly and avoid chasing payments."

Private GP

Incorporating systems like Hero Health for billing and payment management can simplify this process, aiding both the practitioner and the patient.

What about overseas patients?

For patients from overseas or those using travel insurance, you will not be able to invoice without a GOP. Ensure this is obtained prior to their appointment to avoid any issues.

How can private GPs make the process smoother?

Using an effective patient management system is paramount. Systems like EMIS Web can enhance the safety and efficiency of patient care. They integrate clinical decision support and detailed clinical reporting, further easing the management of appointments and supporting the delivery of high-quality care.