Why medical cover should be a health warning: As NHS waiting lists are rising, many are going private … but beware of delays, rising premiums and expensive small print


The ad features a tear-eyed nurse wandering in a shiny clean hospital with a disposable mask.

‘We’re here when it’s important,’ the voiceover boasted.

Filmed during the lockdown, it is the first TV commercial by private hospital operator Spire, which recently reported a 40 percent increase in revenues.

Jumping the queue: 5.6 million patients are reported to be waiting for treatment in the NHS

Like many private healthcare providers, Spire Marketing is in operation, investing in primetime television slots and placing its branding on social media newsfeeds. Its message is simple: We can help you faster than the NHS.

Spire is not the only provider or insurer to tout this line. A Google search of ‘private medical insurance’ brings up dozens of results promising to ‘jump the NHS queue’ or ‘avoid the NHS waiting lists’.

With 5.6 million patients reported to be undergoing treatment under our national health system, it is not surprising that private healthcare providers grasp the opportunity.

But experts warn that the flood of new business could create delays in the independent sector and increase premiums for existing customers.

And it is important that you carefully review the small print of the policy, as it may not meet all your health needs.

Increasing demand

For the first time since operations became widespread in the 1960s and 1970s, private hospitals were offering more hip and knee replacements than the NHS.

Spire alone reported pre-tax profits of 7 4.7 million in the six months to June this year, bringing its revenues to £ 558 million. This is after the provider suffered a 1 231 million loss in 2020.

David Hare, chief executive of the Independent Healthcare Providers Network, says: ‘With record levels of NHS waiting lists, more and more patients are choosing to pay privately to get the care they need.’

There are two ways to get private health care. The first is to take health insurance, which includes free private treatment when you need it.

The second is by paying for care from your own savings.

And the latter is in high demand, as patients are desperate for faster medical care, seeking to pay five-figure sums out of their pocket.

A regular knee replacement, for example, can cost between £ 12,000 and £ 15,000. Nuffield Health says that the demand for operations that pay for current patients exceeds that of the epidemic.

Demand

Demand

And in the second quarter of 2021, Spire recorded an 81 percent increase in funding from patients who fund their own treatment compared to the same period in 2019.

Self-employed HR trainer Lisa Brennan, 45, was one of those who turned to private care after a gallstroke made her feel weak and unable to eat anything except mashed potatoes.

Lisa was told to wait six to nine months for surgery at the NHS. She used her savings to pay £ 7,800 for private surgery

She says: ‘I’ll pay it again if I need to. I was in a lot of pain and this was affecting my workload because I was unreliable and unable to keep up with my income. ‘

A brief look at fundraising sites such as GoFundMe reveals that many patients are seeking help to fund private care. Like Lisa, she reports that she is too painful to wait in the NHS.

And many are now looking ahead because younger patients are leading the charge toward long-term private medical care.

According to Gokampare Health Insurance, the average age of their policyholders has dropped from 40 to 33 over the past year. Richard Jones of GoCampire says: ‘We are seeing a new generation of consumers coming into the market who are more inclined to include private health insurance in their monthly exit.’

Increased fees

But experts say this unprecedented interest in private health care is contributing to delays in waiting lists and the sector.

The demand comes at a time when private hospitals and consultants are facing their own decline due to the epidemic.

At the height of the crisis, providers had to treat NHS patients, but unnecessary treatment was abolished due to government restrictions.

According to the Consumer Group, more than four out of ten health insurance customers have deferred, canceled or interrupted scheduled services due to an epidemic?

This means private providers are catching up too. And insurers have to offer discounts to patients who have been effectively void for months.

Bupa says 99 percent of its eligible customers have been reimbursed for a one-month premium and are working to repay the rest.

The Western Provident Association has paid two concessions worth about 40 percent of their customers’ monthly premium.

Meanwhile, both Aviva and AXA say consumers will see a decline in their health insurance claims by 2020 and 2021 compared to previous years.

Private hospitals are delivering more hip and knee replacements than the NHS for the first time since operations became widespread in the 1960s and 1970s.

Private hospitals are delivering more hip and knee replacements than the NHS for the first time since operations became widespread in the 1960s and 1970s.

But there are fears that these discounts, along with common backlogs in the private sector, may increase premiums.

Brian Walters, managing director of Regency Health, a Cheltenham-based medical insurance broker, says: ‘With the NHS waiting list spiraling, people are turning to private care as insurance or self-paying patients. As a result, waiting lists in the private sector have increased.

‘Some health insurers made concessions last year to consumers who did not use their policies, but claims are increasing and this may be reflected in future premiums.’

Mother Joe McMechan suffered a delay in the private sector for the first time because she was on a four-month waiting list for her son, Arthur, six, to be diagnosed with autism.

Joe had previously said that it would take more than two years for his son to be diagnosed with the NHS.

As Arthur became more aggressive at home, the desperate Joe and her husband Alex dived in and went private. They are paying £ 3,000 so Arthur can be evaluated for attention deficit hyperactivity disorder and sport.

Joe, 34, says: ‘We feel like we are constantly fighting for support. It felt like we were getting nowhere in the NHS. I feel very fortunate that we are able to get private care.

‘While we’re still on the waiting list, it’s still a lot faster than the alternative.’

Joe – a pediatric physiotherapist working in the private sector, with children suffering from brain injuries and with neurological needs – is struggling to find new clients due to increased demand.

She says: ‘Rejecting families who are desperate for help can feel cruel.’

Mr Walters says premiums usually increase by 9 to 14 per cent every year – which is always higher than normal inflation, depending on medical inflation.

But premiums can rise even faster now. How much you pay for insurance depends on the age and health of the customer.

A 35-year-old couple can expect to pay from £ 700 to £ 1,000 a year, while a 55-year-old couple will be charged an average of £ 1,200 to £ 2,000.

According to Mintel’s 2021 Private Health Care Report, the number of people covered by health insurance is estimated at about 5.2 million.

About 75 percent of the policies taken are held in corporate projects, which means they are organized by customer employers.

There are rumors that delaying private health care during the epidemic could lead to a wave of medical negligence claims.

Short print: Health insurance policies are notoriously complex and have many exclusions

Short print: Health insurance policies are notoriously complex and have many exclusions

Stephen Farnworth, a personal injury lawyer from Manchester-based Slater Healys, says: ‘It’s still very early days and a lot of things that happened during the epidemic still have to be played in court.

Overall, it can be very difficult for a person to sue their private providers for delays during a lockdown, as most private health contracts include a clause that covers themselves for significant events such as the epidemic.

‘But I think we can start to see organizations complaining that most people with health insurance get it through their employers, and that coverage is not enough during the epidemic.’

Read the small print

Health insurance policies are notoriously complex and have many exclusions.

For the most part, they do not include pre-existing conditions and are designed to treat routine tests and serious but short-term conditions.

Conditions such as chronic, usually incurable, arthritis or asthma are not standard. James Daley, a publicity firm at Farer Finance, has warned that it is important to read the small print to avoid getting caught.

He says: ‘This year is a great opportunity for insurers. We’ve all been reading the news and we’ve seen that backlogs and waiting lists are at an all-time high in the NHS.

‘But health insurance is messy and people need to carefully examine what’s really involved. Insurers usually include exclusion for existing conditions. They can begin to exclude Covid in their policies.

Unfortunately, when consumers buy insurance, they don’t always look at the finer details. They are more likely to be lured by the freebies offered to sign up.

When things go wrong we can start to see more complaints from insurers. ‘

The Financial Ombudsman has received 1,476 complaints about private medical or dental insurance in fiscal year 2020/2021 – most of the previous year’s 1,021 holdings came from customers who refused to pay.

Mr Daley says: ‘A lot of people still want to see their GP face-to-face, which is currently more available in the private sector than the NHS.

‘I’m sure the government will be delighted by the number of people heading towards private care, as the pressure on the NHS is alleviated. But it takes us further away from the system we have used for more than 70 years. ‘

h.kelly @

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