The Lemon Fool

Lots of useful information on the current thread ‘Anyone experience of private consultations?’ but I didn’t want to hijack it with a similar but different question, namely: what are people’s views on buying health insurance as opposed to self-insuring?

We’ve had a policies with Aviva for many years, and recently my wife has had two claims, both of which have been refused. I’m at the start of a claim myself now, and their process involves me having to request approval at every step, rather than at the start of a claim – so I had an initial consultation (£150), approved, a follow-up consultation (£200), approved, and the next step is surgery. This is likely to be a small number of thousands, which is the stage when the previous claims were refused. As we have a £500 excess you can see Aviva have paid out nil.

I suppose one of the major benefits sought from insurance is peace of mind, which clearly we no longer have.

I wonder how others approach this. Keep a capital sum earmarked? How much would be needed? My approach to insurance is only to insure major items which I can’t afford to pay out myself, like my house burning down, and for us it’s not clear-cut whether we should be insuring. An operation such as a knee replacement at £15k is marginal for us – it’s a stretch, a lot of money, but ultimately we could find it. The £500 excess we chose was because we don’t feel the need to cover a relatively small amount. But what if one of us needs something major – heart operations, cancer treatment – that could be a huge amount which we probably would need to insure against. I don’t have confidence that our current insurers would pay up in the event though.

Interested to hear other views…

MyNameIsUrl wrote:. But what if one of us needs something major – heart operations, cancer treatment – that could be a huge amount which we probably would need to insure against. I don’t have confidence that our current insurers would pay up in the event though.

Wouldn't major operations be covered by the NHS? Or perhaps waiting times would be an issue. (I'm assuming you are in the UK)

Alaric wrote:

MyNameIsUrl wrote:. But what if one of us needs something major – heart operations, cancer treatment – that could be a huge amount which we probably would need to insure against. I don’t have confidence that our current insurers would pay up in the event though.

Wouldn't major operations be covered by the NHS? Or perhaps waiting times would be an issue. (I'm assuming you are in the UK)

My wife and I have private health insurance and we actually take the opposite view. If it is something basic then we will use the NHS e.g. bloodwork, vaccinations, minor injuries and ailments etc.

The private cover is for more serious things where we want the very best and/or do not want to queue with everyone else.

Our coverage is fairly extensive and we haven't had a problem with getting claims paid. However the cover is through my wife's job and is subsidised, so I cannot advise on what it costs if you have to pay the full cost yourself.

If you need something major, the private hospitals will shunt you over to the NHS anyway.

Lanark wrote:If you need something major, the private hospitals will shunt you over to the NHS anyway.

Sure in the sense that it is often the same doctors. But even so one would presumably jump the queue and receive your treatment or surgery in days rather than months, and that is a big part of what you pay for when you go private.

The problem is not that NHS doctors are no good but rather that, in a NHS setting, they are hopelessly over-worked. My takeaway impression from having seen a fair number of doctors privately is that they have more time for you. The focus becomes on excellence rather than throughput.

^ I don't think so, it the private hospital is not setup for a particularly complex procedure you just join the same queue as everyone else.

For long term illnesses such as mental health issues which often affect the elderly, the insurance will often have a get-out clause.

Even if they wheel you into A&E you will be triaged the same as any other arrival.

Lanark wrote:^ I don't think so, it the private hospital is not setup for a particularly complex procedure you just join the same queue as everyone else.

My family has never needed anything serious and so private hospitals have always been able to handle it. Examples are colonoscopy, bunion surgery, cyst removal etc.

Another option is going overseas. I know people who have gone to the US (for the best and most expensive treatments) and to Thailand and Turkey for work at a more reasonable price.

For A&E, the NHS has a monopoly of course.

Lanark wrote:^ I don't think so, it the private hospital is not setup for a particularly complex procedure you just join the same queue as everyone else.

Not my experience - yes, you go to an NHS hospital but in the private wing, in a private room with facilities, with the consultant/surgeon of your choice and without NHS delay.

Lanark wrote:
For long term illnesses such as mental health issues which often affect the elderly, the insurance will often have a get-out clause.

You mean like a clause for not offering cover for mental illness maybe?

MrsF was paying BUPA when I met her, she continued to pay them for over 20 years.

The premiums crept up, at one poiint I noticed they were £250/month (yup, £3k a year, I was less than impressed), at which point she added an excess, and it dropped to £50(!), and then started to rise again.

Her reasoning - "mum's knee would have cost £5k". Her mum was 85 when it was done.

2 years ago, and probably well over £50k poorer, I persuaded her to cancel.

Last month she needed an MRI, and an X-ray, approx 6 month wait on the NHS. There was some mention of she should have stayed in BUPA, until I pointed out that the Nuffield cost was less than the premiums saved in the last 18 months, even without the excess.

We are in a position that should we need to find £20k to fund a major op, we can do. 20 years ago we weren't in the same situation, so private cover had some merit.

MyNameIsUrl wrote:I wonder how others approach this. Keep a capital sum earmarked? How much would be needed? My approach to insurance is only to insure major items which I can’t afford to pay out myself, like my house burning down, and for us it’s not clear-cut whether we should be insuring.

"Budget for the probable, insure against the possible", a good mantra. You don't say what your premiums are, or how much they are from your income, or your state of health, or age, but most people under 60 need nothing, so save the premiums until then

Paul

Bear in mind that less than half the cost of most insurance goes on claims. Most of your premiums go on commissions, overheads, profit etc etc. So statistically you are far better off investing the money you would have paid in premiums and paying for your private health care yourself. Obviously that is an average! I had private healthcare for my family for several decades paid for by my job and when I retired I decided not to insure but just to pay up myself. I have spent a lot on private medicine but probably less than I would have spent in premiums and without the hassle of claims and worrying about what was covered and what was not.