Blood Tests in Private Health Insurance Whats Included
As an FCA-authorised expert broker that has helped arrange over 900,000 policies, WeCovr understands the nuances of private medical insurance in the UK. This guide explains what you need to know about cover for blood tests, from basic checks to advanced diagnostics, helping you navigate your policy with confidence.
Overview of basic, advanced and specialist blood test cover
Blood tests are a cornerstone of modern medicine. They are essential diagnostic tools that help doctors understand what’s happening inside your body, from checking your organ function to identifying markers for specific diseases. When you have private medical insurance (PMI), one of the key benefits is faster access to these diagnostics.
However, a common point of confusion is which blood tests are actually covered. The answer isn't always straightforward. In the UK, private health cover is designed to treat new, acute conditions that arise after your policy begins. This principle is the key to understanding blood test cover.
Put simply: if a specialist needs a blood test to diagnose a new symptom you're experiencing, your PMI policy will almost certainly cover it, provided you have the right level of outpatient cover. Conversely, tests for managing long-term (chronic) illnesses, general health screening without symptoms, or issues you had before taking out cover are typically excluded.
This guide will break down the cover for basic, advanced, and specialist blood tests, so you know exactly where you stand.
How Private Health Insurance Covers Blood Tests
Understanding the process is the first step to using your policy effectively. Getting a blood test on private medical insurance isn't as simple as walking into a clinic and requesting one. It follows a clear, medically-led pathway.
The Standard Pathway:
- You develop new symptoms. For example, unexplained weight loss, persistent fatigue, or unusual pain.
- You visit your NHS GP. Your GP is your first port of call. They will assess your symptoms. If they feel you need to see a specialist, they will provide you with a referral letter.
- You contact your insurer for pre-authorisation. With your GP referral, you call your PMI provider. They will approve a consultation with a private specialist (e.g., a cardiologist, gastroenterologist, or endocrinologist) from their approved network.
- The specialist orders the blood tests. During your consultation, the specialist will determine which diagnostic tests are medically necessary to find the cause of your symptoms. This is the point where blood tests are requested.
- Tests are authorised and performed. The hospital or specialist's clinic will seek authorisation from your insurer for the specific tests. Once approved, you can have your bloods taken, often in the same private hospital.
The most critical factor determining your cover for these tests is your outpatient limit.
Inpatient, Day-Patient, and Outpatient Cover Explained
- Inpatient/Day-Patient Cover: This covers tests and treatment when you are admitted to a hospital bed, even if just for the day. Blood tests performed while you are an inpatient (e.g., before surgery) are usually covered as standard.
- Outpatient Cover: This is for diagnostics and consultations that don’t require a hospital bed. This is where most diagnostic blood tests fall. You see a specialist, they order tests, and you go home the same day.
Policies come with different levels of outpatient cover, which directly impacts your access to blood tests:
| Outpatient Cover Level | Typical Limit | Impact on Blood Test Cover |
|---|---|---|
| Basic | £0 - £500 | Very limited. A specialist consultation can cost £200-£300, leaving little to nothing for blood tests or other scans. You would likely pay for tests yourself. |
| Mid-Range | £1,000 - £1,500 | Good cover. This is usually sufficient to cover several specialist consultations and a good range of diagnostic tests, including multiple blood panels. |
| Comprehensive | Unlimited / "Full Cover" | The best option. This covers all eligible outpatient consultations and diagnostic tests recommended by your specialist without a financial cap, giving you complete peace of mind. |
Choosing a policy with adequate outpatient cover is vital if you want your diagnostic blood tests included.
What Are Basic Blood Tests and Are They Included?
Basic blood tests, often called a "blood panel," are routine investigations used to get a broad overview of your health. They are frequently used by specialists to narrow down the cause of common symptoms.
As long as they are for diagnosing a new, acute condition, these tests are almost always covered by a private medical insurance UK policy with sufficient outpatient cover.
Common Basic Blood Tests Covered by PMI:
- Full Blood Count (FBC): Checks the levels of your red cells, white cells, and platelets. It can help detect conditions like anaemia, infection, and inflammation.
- Urea and Electrolytes (U&Es): Assesses kidney function and your body's electrolyte balance. Essential for investigating issues like dehydration, fatigue, or high blood pressure.
- Liver Function Tests (LFTs): Measures enzymes and proteins made by your liver. Used to diagnose liver damage or disease if you have symptoms like jaundice or abdominal pain.
- Thyroid Function Tests (TFTs): Checks if your thyroid gland is working correctly. Often used to investigate fatigue, weight changes, or mood swings.
- Lipid Profile (Cholesterol Test): Measures levels of cholesterol and other fats in your blood. A specialist might order this if investigating symptoms related to heart or circulatory issues.
- HbA1c: This test measures your average blood sugar over the past three months. While it's famously used to monitor diabetes (a chronic condition), a specialist may use it for diagnostic purposes if you present with symptoms like excessive thirst and fatigue, to rule out new-onset diabetes.
Real-Life Example:
David, 45, has been feeling unusually tired and weak for a month. His GP can't find an obvious cause and refers him to a general physician privately. David calls his insurer, gets authorisation, and sees the specialist. The specialist suspects potential anaemia or a thyroid issue and orders an FBC and TFTs. Because these tests are to diagnose the cause of his new symptoms, his PMI policy (with a £1,500 outpatient limit) covers the consultation and the blood tests in full.
Understanding Advanced Blood Test Cover in PMI
Advanced blood tests are more specific and often more expensive. They look for particular markers that can point to less common conditions. The principle for cover remains the same: they must be medically necessary to diagnose an eligible, acute condition.
Examples of Advanced Blood Tests and Their Coverage:
- Hormone Panels: If a specialist suspects an endocrine disorder like Cushing's syndrome or Addison's disease based on your symptoms, they may order detailed hormone tests. These are generally covered as part of the diagnostic process.
- Vitamin Deficiency Tests: While a general "check my vitamins" test isn't covered, if you have specific symptoms pointing to a deficiency (e.g., neurological symptoms for B12 deficiency), a specialist can request the test, and it will likely be covered.
- Coeliac Disease Serology: If you have gastrointestinal symptoms and a specialist suspects coeliac disease, the blood tests to look for specific antibodies are covered as part of the diagnosis.
- Tumour Markers (e.g., PSA, CA-125): These are substances that can be elevated in the presence of some cancers. If a specialist orders them to investigate specific symptoms (e.g., a PSA test for a man with urinary problems, or a CA-125 for a woman with abdominal bloating), they are covered. However, they are not covered as a general screening tool in someone with no symptoms.
The key is always the consultant's justification. The insurer will want to know why the test is needed and what condition it is intended to diagnose.
Specialist Blood Tests: Cancer, Genetics, and Allergies
This is where private medical insurance can be incredibly valuable, offering access to cutting-edge diagnostics that may have longer waits on the NHS. However, the rules are also at their strictest here.
Cancer Markers
As mentioned, tumour marker tests like PSA (prostate) and CA-125 (ovarian) are covered when used to investigate suspicious symptoms. More advanced cancer-related blood tests, such as those used to guide treatment choices (e.g., genomic testing of a tumour), are often included under the cancer cover benefit of a comprehensive policy, which is one of the most valued features of PMI.
Genetic Testing
This is a complex area. Standard PMI policies do not cover predictive genetic testing – that is, a test to see if you carry a gene that might cause a disease in the future (e.g., the BRCA gene for breast cancer risk).
However, if you have symptoms of a specific inherited disorder, a genetic test might be covered if it is the definitive way to diagnose your current, active condition. This is decided on a case-by-case basis and requires strong justification from your specialist.
Allergy Testing
If you develop new symptoms like hives, swelling, or digestive issues, your GP may refer you to an allergist or immunologist. Blood tests like the RAST (radioallergosorbent test), which measures IgE antibodies to specific allergens, are typically covered by your PMI policy to help diagnose the cause of your new allergic reactions.
| Test Category | Typically Covered For Diagnosis? | Typically Excluded For Screening? |
|---|---|---|
| Cancer Markers | Yes, when investigating specific symptoms. | Yes, if there are no symptoms (general screening). |
| Genetic Tests | Rarely, only to diagnose a current symptomatic condition. | Yes, for predictive screening to assess future risk. |
| Allergy Tests | Yes, to find the cause of new allergic symptoms. | Yes, if you just want to "check for allergies" without symptoms. |
The Crucial Exclusions: What Your PMI Won't Cover
Understanding what is not covered is just as important as knowing what is. The exclusions on a private medical insurance UK policy are clear and universal across the industry.
- Chronic Conditions: This is the most important exclusion. PMI is for acute conditions (curable, short-term illnesses). It does not cover the routine monitoring or management of chronic conditions like diabetes, asthma, hypertension, or diagnosed autoimmune diseases. Therefore, regular blood tests to monitor your blood sugar for diabetes or check inflammatory markers for rheumatoid arthritis would not be covered.
- Pre-existing Conditions: Any medical condition for which you have had symptoms, medication, or advice in the 5 years before your policy started is considered pre-existing. Standard policies will not cover treatment or diagnostics for these conditions.
- Routine Screening and Wellness Checks: A standard PMI policy does not cover "health MOTs" or blood tests you want "just in case" or for general peace of mind. The entire process must be triggered by new symptoms. Some policies offer a separate wellness benefit, which we discuss below.
- Fertility: Blood tests to investigate or manage infertility are a standard exclusion on most PMI policies.
- Lifestyle and Performance Tests: Tests to optimise athletic performance, "anti-ageing" hormone profiles, or nutrition-based blood panels without a doctor's referral for a specific medical symptom are not covered.
The NHS vs. Private Route for Blood Tests: A Comparison
Both the NHS and the private sector provide excellent diagnostic services, but they serve different purposes. The main advantage of private cover is speed.
According to NHS England data, the waiting list for diagnostic tests remains a significant challenge. As of mid-2024, hundreds of thousands of patients were waiting over 6 weeks for key tests. While not all of these are for blood tests, it reflects the pressure on the system that leads to delays in seeing a specialist in the first place.
Here’s how the two routes compare:
| Feature | NHS Route | Private Route (with PMI) |
|---|---|---|
| Cost | Free at the point of use. | Paid for by your insurance premium (and any excess). |
| Referral | GP refers you to an NHS specialist. | GP refers you; you choose a private specialist from your insurer's list. |
| Waiting Time | Can be weeks or months to see a specialist, delaying the tests. | Can be days to see a specialist, meaning tests happen much faster. |
| Scope of Tests | Comprehensive. All medically necessary tests are available. | Comprehensive for diagnosing acute conditions, subject to policy limits. |
| Exclusions | No exclusions based on pre-existing or chronic conditions. | Excludes pre-existing and chronic conditions, plus screening. |
| Convenience | Appointments are scheduled for you at an NHS facility. | You can often choose the time and location of your appointment at a private hospital. |
The Rise of Wellness Benefits and Health Screening in PMI
Insurers recognise that many people want to be proactive about their health. In response, many modern PMI policies now include a separate wellness or screening benefit.
This is not the same as your core diagnostic cover. It's an added perk, often with its own set of rules and limits.
- What it is: A contribution towards, or full cover for, a health screening package at set intervals (e.g., every one or two years).
- What it includes: These screenings often include a set of basic blood tests (e.g., cholesterol, liver function), a physical examination, and other measurements.
- How it works: You don't need symptoms or a GP referral. You simply book the health check through your insurer's approved provider.
This is a great benefit, but it's important not to confuse it with the unlimited diagnostic power of your main outpatient cover. At WeCovr, we can help you compare policies from providers like Aviva, Bupa, and Vitality to see which ones offer the most valuable wellness benefits to complement their core cover.
Furthermore, as a WeCovr client, you get complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, helping you stay on top of your health goals. You can also benefit from discounts on other insurance products when you take out a PMI or life insurance policy with us.
How to Get Blood Tests Covered by Your Private Medical Insurance: A Step-by-Step Guide
If you have symptoms and want to use your PMI, follow these steps to ensure a smooth process.
- See Your GP: This is the non-negotiable first step. Explain your symptoms and ask for an "open referral" letter if they agree you need to see a specialist. An open referral doesn't name a specific doctor, giving you more flexibility with your insurer.
- Call Your Insurer: Have your policy number ready. Tell them your symptoms and that you have a GP referral. They will give you a pre-authorisation number for the specialist consultation and confirm which specialists or hospitals are covered.
- Book Your Specialist Appointment: Contact the specialist's secretary to book your initial consultation. Give them your PMI policy details and pre-authorisation number.
- Attend the Consultation: The specialist will assess you. If they decide blood tests are needed, their team will usually handle the next step.
- Confirm Authorisation for Tests: It is your responsibility to ensure the tests are authorised by your insurer before you have them. The hospital will often do this, but it's wise to double-check. Ask the specialist's secretary, "Have the blood tests been pre-authorised by my insurer?"
- Have the Blood Tests: Once approved, you can have your blood sample taken at the private clinic or hospital.
- Follow Up: Your specialist will receive the results and will typically arrange a follow-up consultation (which also needs pre-authorisation) to discuss them with you and plan your treatment.
Choosing the Right PMI Policy for Blood Test Cover
When you're comparing policies, the level of diagnostic cover is one of the most important considerations. Here's what to focus on:
- Outpatient Limit: As shown earlier, this is the single biggest factor. For peace of mind, a "full cover" or unlimited outpatient option is best. If your budget is tighter, a mid-range limit of £1,500 is a good compromise.
- Policy Excess: This is the amount you agree to pay towards a claim each year. A higher excess will lower your premium, but you'll have to pay that amount before the insurer pays out. Make sure you're comfortable with the excess level.
- Hospital List: Check which hospitals are on your policy's list. Ensure there are convenient, high-quality private hospitals near you that offer a full range of diagnostic services.
- Expert Guidance: Navigating the options can be overwhelming. A specialist PMI broker like WeCovr can be invaluable. We don’t charge you a fee for our service; we get paid by the insurer you choose. Our experts compare the entire market to find a policy that fits your specific needs and budget, explaining the fine print so there are no surprises. With high customer satisfaction ratings, our team is dedicated to finding the best private health cover for you.
Real-Life Scenarios: Blood Test Cover in Action
| Scenario | Symptoms | Specialist Referral | Blood Test Request | Is it Covered by Standard PMI? |
|---|---|---|---|---|
| 1. The Acute Condition | Maria, 34, develops sudden, severe joint pain and swelling in her hands. | GP refers her to a Rheumatologist. | The specialist orders a full blood count, inflammatory markers (ESR, CRP), and a rheumatoid factor test to investigate possible arthritis. | Yes. The tests are to diagnose a new, acute condition. Cover is subject to her outpatient limit. |
| 2. The Chronic Condition | Tom, 60, was diagnosed with Type 2 diabetes 5 years ago. His policy started last year. | He wants his annual diabetes check-up. | He needs an HbA1c test to monitor his blood sugar control. | No. This is routine monitoring of a pre-existing, chronic condition, which is a standard exclusion. |
| 3. The Wellness Check | Chloe, 28, feels perfectly healthy but wants to be proactive. | No symptoms, no GP referral. | She wants a full "health MOT" blood panel, including vitamins, cholesterol, and liver function, "just to check". | No. This is screening without symptoms and is not covered by a standard policy. However, if her policy has a separate wellness benefit, she could use that. |
Does private health insurance cover routine blood tests?
Do I need a GP referral for blood tests on my private medical insurance?
Are blood tests for pre-existing conditions ever covered?
What happens if my outpatient limit isn't enough to cover my blood tests?
Navigating the world of private medical insurance can feel complex, but it doesn't have to be. Understanding how your policy covers diagnostics like blood tests is the key to making the most of your cover.
Ready to find a policy that gives you fast access to the diagnostics you need?
Get a free, no-obligation quote from WeCovr today. Our expert advisors will compare the UK's leading insurers to find the right cover for your needs and budget.
Related guides
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
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Questions to ask yourself regarding private medical insurance
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Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
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Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
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Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
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