With his huge experience in treating international private patients, one of the most senior Consultant Physicians in London, Dr Nigel Kellow has spoken openly about the differences between the private medical insurance (PMI) offered in the UK, and insurance available in America. This is especially in the context following the Affordable Care Act (ACA). The ‘real life’ cases used here are examples of what he and his colleagues see every day. Some of the differences are quite profound. UK patients need to be aware of some of the critical pitfalls that are placed in their path.
Isn't your treatment covered?
Dr Kellow has lists the major differences between the UK and US, and has tried to provide insight into some of the most frequent situations. This article provides a summary of the key points and gives examples of those key patient interactions where UK patients are shocked to learn that despite paying high medical premiums, it turns out that they are not actually covered.
What is covered by Private Medical Insurance and what isn’t?
I’m a consultant in private practice in London and I treat patients covered by private medical insurance every day. If you think it’s better in the UK, think again. I’ll share some stories I and my colleagues see every day. After reading these please to contact me and share your own experiences.
Is PMI in the UK is specifically designed around the NHS core service?
Patient question; PMI in the UK is designed for a country that already has an NHS. It’s specifically for the things that the NHS does badly, namely elective procedures with waiting lists. It’s not really fair to compare ACA which is designed for a country that has no basic free level of care is it?
Dr Kellow; What exactly does the NHS do well? Once you’re in front of a consultant - having surgery, undergoing treatment, etc - you’ll get excellent care, but the great British claim that the NHS is the best health system in the world is a political fallacy massaged and promoted by politicians of all the main parties. It is irretrievably broken and my point is that PMI is not and never can be a substitute.
Patient response; It’s just ‘free’ so they think it’s good. PMI mixed with a proper and narrow level of free care is the best option. Germany, Netherlands or France are good examples.
Dr Kellow’s response; Exactly. And there’s another political lie. It’s not free. In 2021 healthcare cost £4,188 per person. According to the official UK government information, that’s £349 per person per month.
Is there a misconception that US health insurance is worse than UK PMI?
Here are included some comparisons between UK PMI and the Affordable Care Act (ACA), which is sometimes also called "Obamacare". Let's compare what is covered and what isn't.
1. PMI in the UK doesn’t cover chronic conditions. Almost one in three people have at least one chronic condition including; Hypertension, heart failure, neurodegenerative conditions, diabetes, epilepsy, asthma, CKD, back pain - none of which are covered!
Chronic conditions are covered from day 1 under ACA.
2. PMI doesn’t cover emergencies either. A personal story. One lunchtime between morning theatre and afternoon clinic I got a fishbone stuck in my throat. I couldn’t speak or swallow. I managed to find a kind ENT colleague to take it out, but WPA refused to cover the hospital bill.
The insurance company said: “That’s not what PMI is for. It’s what the NHS is for.” So, cancel all my afternoon clinic patients and go and spend 12 hours in A&E?
Emergencies are covered straight away under the ACA.
3. UK PMI doesn’t cover pre-existing conditions, but they all have to be covered from Day 1 under the ACA. For example, a minor shoulder problem. No surgery. No symptoms for 12 years. WPA, a small UK PMI, refused to cover it - for ever.
4. A young patient with back pain. First presentation 6 months earlier. No surgery. No injections. Only physiotherapy. Again WPA - calls it chronic and refuses to cover it. Patient might need major spine surgery, so PMI pulling the plug before patient can cost them money.
5. An older patient who doesn’t want or need spinal surgery. Hasn’t had any back problem for 10 years but gets an acute problem they’ve never had before. BUPA says it’s chronic and denies coverage. The UK Financial Ombudsman says, “We don’t regulate insurers”, and sides with BUPA.
Under the ACA, insurers can’t charge the oldest person more than 3x the youngest person. No such regulation exists in the UK, so many younger people pay less than £50 per month, while older people pay over £1,500 per month (30x) - and they still won’t be covered for pre-existing or chronic conditions.
You’re paying for it remember!
PMI brokers in the UK can be paid 60% or more of the whole of the first year’s premium for signing up a new customer, or persuading one to switch from one to another insurer, but you’ll never know because the FCA doesn’t oblige them to tell customers. You’re paying for it remember!
Chronic condition exclusion
The PMI chronic condition exclusion is deceitful artifice. What aspect about getting older is not chronic? They cover only what they feel they have to in order to sell policies. For example, joint replacements are covered, but arthritis is chronic, atherosclerosis (ACVD) is chronic, and cancer is, of course, chronic.
Is UK PMI is regulated?
Short answer, no. UK PMI covers 7 million people and generates £5.5 billion in premium revenue, which is subject to 12% insurance premium tax. But the PMI product is not regulated. The FCA and PRA regulate them as financial institutions, but there is no public protection for the product they sell.
Are PMI concerns responded to?
I highlighted my concerns about the industry last year in an email to the CEOs of the FCA and the CMA. My email was read over 1,200 times in several countries, but I never got a reply. It makes you wonder what is going on, and you could be forgiven for asking; Is PMI too important to be allowed to fail given the state of the NHS?
