Using your private medical insurance

A few simple steps make using your insurance straightforward. Obtaining pre-authorisation before you attend is your responsibility as the policyholder, and it protects you from unexpected costs:

• Check that your policy covers outpatient consultations and investigations
• Contact your insurer to obtain a pre-authorisation code before your appointment
• Have your membership and authorisation details ready when you book
• Ask your insurer whether you need a GP referral, as most insurers require one

Dr Borukhson is fee assured with the insurers she works with. In practice this means her fees are recognised by those insurers, so for eligible appointments there is generally no shortfall for you to top up, provided your policy covers the treatment and you have the necessary authorisation.

You can see the insurers she works with, along with self-pay fees, on the fees page.

Using insurance does not change how your appointment runs. You are seen, assessed and given the same time and care as anyone paying for themselves, and there is usually nothing to pay at the desk for the consultation itself. The practical side is mostly paperwork done in advance.

It helps to bring a few things with you:

• Your insurance membership number and the pre-authorisation code for your visit
• A GP referral letter if your policy requires one
• A note of any excess on your policy, so you know whether the first part of a claim falls to you

In most cases the fee for an eligible, pre-authorised appointment is invoiced directly to your insurer, so you do not need to pay first and claim back. Where your policy carries an excess, that is the portion you are responsible for, and your insurer will usually deduct it from what they pay, leaving the practice to collect the balance from you. If you also have investigations on the day, such as blood tests or a scan, those may be billed separately, which is why it is worth confirming in advance that your authorisation covers them. Consultation fees are published, and the cost of any investigation or procedure is agreed with you in advance, so you always know what any self-funded element would cost.

For a fuller picture of what an appointment itself involves, see the guide on your first rheumatology appointment.

Occasionally a policy does not cover part of a visit, or an insurer declines a claim, most often because pre-authorisation was not obtained, the policy has an exclusion or a limit, or a GP referral was needed but not in place. This is usually straightforward to resolve and need not stand in the way of your care.

If it happens, a few things help:

• Speak to your insurer first. They can explain the reason and tell you whether obtaining authorisation or a referral after the fact, or appealing the decision, is possible.
• Ask exactly what is and is not covered, so any remaining cost is clear rather than a surprise.
• Consider self-pay for the uncovered part. Where insurance does not apply, consultation fees are set out on the fees page and the cost of any investigation or procedure is agreed with you in advance, with no hidden costs, and you can simply pay for that element yourself.

The aim is always that you understand any cost before it arises. Whether a claim is met in full, met in part, or you choose to pay for yourself, you receive the same assessment and follow-up.

You do not need insurance to be seen. Self-pay appointments are welcome, and the fees are set out clearly on the fees page so you know what to expect. Private appointments, whether insured or self-pay, are arranged through the practice.

What is pre-authorisation and why do I need it?

Pre-authorisation is your insurer confirming, in advance, that they will cover your appointment and any investigations, usually by issuing an authorisation code. Obtaining it before you attend is your responsibility as the policyholder, and it protects you from unexpected costs. Contact your insurer ahead of time, have your code and membership details ready when you book, and check whether you need a GP referral, as most insurers ask for one.

What does fee assured mean, and will I have to pay anything extra?

Fee assured means Dr Borukhson's fees are recognised by the insurers she works with. In practice, for eligible appointments there is generally no shortfall for you to top up, provided your policy covers the treatment and you have the necessary authorisation. It is still worth confirming your own cover, as policies differ. You can see the insurers she works with on the fees page.

Do I need private insurance to be seen?

Not at all. You are very welcome to pay for yourself, and many patients do. Self-pay fees are set out clearly on the fees page so you know what to expect, with no hidden costs. Whether you are insured or paying for yourself, appointments are arranged in the same way through the practice, and you receive the same care and time.

Will my insurer cover scans and tests as well as the consultation?

This depends on your individual policy. Many cover outpatient investigations such as blood tests and imaging, but some have limits or exclude certain things, so it is worth checking before you attend. When you contact your insurer for pre-authorisation, ask specifically whether investigations are included. If anything is not covered, the cost is agreed with you in advance so there are no surprises.

What should I do before my appointment if I am using insurance?

A few simple steps make things straightforward. Check that your policy covers outpatient consultations and investigations, contact your insurer to obtain a pre-authorisation code, and ask whether you need a GP referral. Have your membership and authorisation details to hand when you book. Sorting this out in advance helps your appointment run smoothly and avoids any unexpected costs later.