Paying for private medical care, from self-pay to insurance

The ways to pay for private care

Private care is paid for in four main ways, and many people combine them. You can pay yourself, an employer can pay directly or through a company scheme, a private medical insurance policy can meet the cost of covered treatment, and a travel policy can reimburse care you need away from home.

Each route has its own rules about what it covers and the paperwork it needs. Decide how you will pay before the appointment, and the receipt or invoice can be issued in the right form the first time.

Paying for yourself

Paying yourself is the simplest route, because you choose the doctor and the timing and nobody has to authorise anything first. Ask for the fee in writing beforehand, with what it includes. Under the Consumer Rights Act 2015, what a clinic says or writes about its service becomes part of your contract when you rely on it in deciding, and the service must be carried out with reasonable care and skill [1].

Medical care from a registered doctor is exempt from VAT when its main purpose is to protect, maintain or restore your health [2]. A report written only so that an insurer or a court can make a decision is taxed at the standard rate, and medicines supplied separately from treatment, such as a private supply for travel, are usually taxed at the standard rate as well [2].

Claiming on private medical insurance

Some insurers recognise our doctors, see our insurers page. When yours does, you can be seen directly and we bill the insurer, and when it does not, you pay us and claim the cost back with an itemised receipt [3]. Cover itself is decided by the insurer, so check your policy before you begin [3].

Ask your insurer before treatment whether it needs a GP referral or authorisation first. The Financial Ombudsman Service hears complaints about claims refused because treatment was not authorised in advance, and about pre-existing conditions a policyholder did not know were excluded [4]. If you are unhappy with a decision, complain to the insurer first, and if you have no final response within eight weeks you can take it to the Ombudsman [4].

When a specialist follows, the consultant and the tests are often covered with a GP referral, while a navigation fee usually is not, and the referral can be written in the form your insurer needs [5].

When your company pays

An employer can pay a clinic directly, provide cover through a group scheme, or reimburse you. In the UK an employer that provides medical treatment or insurance has tax and reporting obligations, and some benefits are exempt, including one health check or screening a year and treatment for someone working overseas for the employer who needs it there [6].

Under a group policy you are a beneficiary of the cover and your employer is the policyholder [4]. Agree before the appointment who is invoiced and in whose name. Information about your health is special category data with extra conditions on its use [7], so a company paying the invoice sees the invoice, and anything clinical only with your agreement.

Paying for care while you travel

Away from home, expect to pay first and claim later. The FCDO says you will often have to pay for medical care abroad up front even when you are fully insured, and asks you to keep receipts and doctors’ notes for your insurer [8]. The CDC gives the same advice, to be ready to pay at the time of care and then send the insurer copies of bills and invoices [9].

If you are visiting London with travel insurance, you pay us and receive a receipt with a doctor’s letter written for your insurer, which many travel policies reimburse [10].

Questions to ask before you agree a fee

Ask these before the first appointment, and keep the answers with your receipts.

• What does the fee include, and what is billed separately?
• Will you confirm the fee in writing before the appointment?
• Does my insurer recognise this doctor, and does it need a referral or authorisation first?
• Who issues the invoice, and in whose name?
• Will the receipt be itemised, with the doctor’s name on it?
• If a specialist or a scan follows, who bills it, and when will I know the price?
• Does my employer or my travel policy need anything particular on the paperwork?

Membership or paying per visit

Paying per visit suits an occasional need. Membership is for people who want a doctor who knows them, priority access and continuity all year, with the planning around their health arranged for them. It is private primary care and sits alongside insurance, which pays for hospital treatment, specialists and surgery, and many members keep both [11].

How The Wellness can help

Every fee is published, and the same fee applies whether you pay yourself or a recognised insurer pays [3]. A GP appointment is £150, and anything that follows, such as a consultant or a scan, is billed by whoever provides it, with each fee told to you before you agree [5].

Our clinics are on Baker Street in Marylebone and Eccleston Street in Belgravia, open from seven in the morning to nine at night every day, and every doctor is GMC registered. For a firm, The Wellness for teams brings leaders and their families under one membership, with one invoice renewed once a year.