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24

Treatment not deemed to be

medically necessary

Some insurance companies use care

guidelines that may not match the

professional medical opinion of nursing

staff, your Consultant and other medical

professionals providing your treatment. In

some cases this can result in certain parts

of the care we have provided not being

funded by your insurer.

Consultant Professional Fees

In most cases Consultant fees are billed

separately, and does not form part of

hospital issued invoices. It might be

advised to check with your insurer and or

sponsor if there are any additional actions

you need to take regarding these.

Cosmetic surgery and treatments

Cosmetic surgery is not generally

undertaken for the treatment of a medical

condition and is therefore excluded from

most UK insurance policies.

If you are unsure about your insurance

coverage, please speak to our staff who can

help you to contact your insurance company.

Pre-Authorisation

Most private medical insurance

companies now require claims to be

authorised before a patient may be treated

at a private hospital. If confirmation of

cover cannot be obtained by the time of

admission/registration, you will be treated

as self funding and asked to pay a deposit

or settle the account in full and claim

back from your insurer. Exclusions may be

due to your previous medical condition

or to a general exclusion within your

policy, for example: pregnancies following

assisted conception treatment. It is always

wise to check for any exclusion or benefit

limits before commencement of treatment.

Six-Week Clause

Some insurance policies contain a

six-week clause, which permits private

medical attention only if you cannot be

admitted to an NHS hospital within six

weeks; it is imperative that the patient

discusses this with their Consultant and

insurance company before the planned

treatment date.

Direct Settlement, Shortfalls

and Exclusions

The claim form must be completed by

the patient or their representative and

forwarded to the Consultant or GP

arranging treatment.

International policies

HCA has agreements with a number of

overseas insurance companies that sell

international medical insurance products.

If no agreement is in place, the patient

is required to pay in full and claim back

monies from their insurer at a later date.

Sponsored patients

If a company, employer or other third

party agrees to settle the account, they

will need to provide a letter of guarantee

along with a deposit. We accept direct

settlement arrangements only with third

parties with whom we have a prior

arrangement. If such an agreement is not

in place, the patient will be asked to settle

their account with us and seek to recover

the sum from their sponsor.

Letters of guarantee must be addressed

to the hospital and must be patient,

treatment and date specific including

relevant reference numbers. The letter will

need to specify any charges that are not

included and any special requests for the

format of the account.

Self-funding patients

We require payment in full or a deposit on

or before the time of treatment for self-

funding patients. The hospital may require

further payments on account, with payment

of the balance in full on discharge.

The value of the deposit will vary with

treatment and is at the discretion of the

hospital providing treatment. Organising

payment in advance of your treatment will

save considerable time on the day of your

visit particularly at times when activity is

high. Quotations or estimates given by

a physician, Consultant or their staff are

not valid unless confirmed in writing by

the hospital. Hospital prices are normally

subject to annual review.

Packaged Accounts

Packaged accounts are billed as a one

line bill, are normally discounted, and

assume a routine stay without medical

complications. They are offered on the

basis that full payment is made before,

or on admission, and payment for any

additional items is settled before discharge.

Package prices do not usually include:

• Ambulance charges

• Telephone or personal expenses, guest

meals etc.

• Outpatient drugs and dressings

• Specialist medication

• Physiotherapy aids, crutches, neck

braces etc.

• Companion fees

• Special nursing

• Histology tests

• Additional night(s)

• Additional procedure(s)

YOUR GUIDE TO REGISTRATION

HCA Hospital information

Payment and insurance