How to Find Out if Your Preferred Consultant is Covered
Finding the right private medical insurance in the UK is about more than just price; it's about access to the care you want, when you need it. As an FCA-authorised broker that has helped arrange over 800,000 policies, WeCovr understands that for many, this means being seen by a specific, trusted consultant. This guide explains exactly how to check.
Step-by-step with provider tools, directories, and what to do if not listed
One of the most powerful benefits of private health cover is the ability to choose your specialist. Whether you have a consultant in mind from a personal recommendation, previous experience, or their renowned expertise, ensuring they are covered by your policy is a critical step. Navigating insurer lists and policy jargon can feel daunting, but it's a straightforward process once you know how.
This comprehensive guide will walk you through:
- Understanding how insurers create their consultant lists.
- A step-by-step process for checking cover, both before and after you buy a policy.
- An overview of the main UK providers' online tools.
- Practical steps to take if your preferred specialist isn't listed.
Why Your Choice of Consultant Matters
When you're facing a health concern, the person guiding your treatment is paramount. While the NHS provides outstanding care, private medical insurance offers a different dimension of control and choice.
Here’s why having a say in your choice of consultant is so important:
- Specialist Expertise: You may have researched a particular consultant who is a leading expert in treating your specific acute condition.
- Personal Recommendation: A friend, family member, or your GP may have recommended a specialist with an excellent track record and bedside manner.
- Continuity of Care: You might have seen a consultant privately for an initial consultation and wish to continue your treatment journey with them.
- Location and Convenience: Your preferred consultant may practice at a hospital that is convenient for you and your family.
- Peace of Mind: Simply knowing you are in the hands of a specialist you trust can significantly reduce anxiety and aid recovery.
According to NHS England data, the total waiting list for consultant-led elective care stood at around 7.54 million in early 2024. While PMI doesn't replace the NHS, it provides a valuable alternative for eligible conditions, often allowing you to bypass these queues and see a specialist of your choice much faster.
Understanding Your PMI Policy's Consultant List
Private medical insurers don't simply cover any consultant in the UK. They work with a network of approved specialists and hospitals. Understanding the terminology is the first step to navigating these networks effectively.
A Critical Note on Coverage Scope
Before we dive in, it is essential to understand a fundamental principle of private medical insurance in the UK: policies are designed to cover the diagnosis and treatment of acute conditions that arise after you take out the policy.
PMI does not cover pre-existing conditions (illnesses or injuries you had before the policy start date) or chronic conditions (illnesses that are long-term and require ongoing management, like diabetes or asthma).
Key Terms You Need to Know
| Term | Simple Explanation | What it Means for You |
|---|---|---|
| Consultant Network/List | The official list of specialists an insurer has approved and will pay for. | If your consultant is not on this list, your policy may not cover their fees in full, or at all. |
| Fee-Assured Consultant | A specialist who agrees to charge within the fee guidelines set by an insurer. | Your insurer will cover their fees in full (subject to your policy limits). You won't face any unexpected shortfalls for their time. |
| Non-Fee-Assured Consultant | A specialist whose fees may be higher than what the insurer is prepared to pay. | If you choose to see them, the insurer will only pay up to their set limit. You will have to pay the difference (the "shortfall") yourself. |
| Guided Consultant List | A smaller, curated list of consultants offered by an insurer, often in exchange for a lower premium. Sometimes called a "Guided Option" or "Consultant Select". | This reduces your choice but can make your policy significantly more affordable. It's a trade-off between choice and cost. |
| Open Referral | Your GP refers you to a type of specialist (e.g., "a cardiologist") rather than a named individual. | The insurer will then typically offer you a choice of 2-3 fee-assured specialists from their network for you to choose from. This is common with guided options. |
Understanding these distinctions is crucial. A "comprehensive" policy might give you access to thousands of consultants, while a "guided" policy will be more restrictive. An expert PMI broker can help you weigh the pros and cons of each approach based on your priorities and budget.
A Step-by-Step Guide to Checking Consultant Cover
Follow this process to ensure you're never caught out by surprise fees or coverage denials.
Step 1: Before You Buy a Policy
This is the best time to check. Building your policy around your needs from the start is far easier than trying to adapt later.
- Identify Your Preferred Consultant(s): Make a short list of any specialists you would want to see. Note their full name and, if possible, the hospital(s) where they practice.
- Use Insurers' Online Finders: Most major UK insurers have a public-facing online tool to search for specialists. You can typically search by name, speciality, or location. We explore these tools in more detail below.
- Check for "Fee-Assured" Status: When you find your consultant in an insurer's directory, pay close attention to their status. The tool should clearly state if they are "fee-assured" or partnered with that insurer.
- Work with a PMI Broker: This is the most efficient method. An independent broker, like WeCovr, has access to information from across the market. You can simply tell us who your preferred consultant is, and we can quickly identify which insurers and which specific policies will cover them. This saves you hours of research and ensures you are comparing like-for-like.
Step 2: If You Already Have a Policy
If you're already insured, the process is slightly different.
- Review Your Policy Documents: Your policy schedule and terms will state what type of consultant access you have. Look for keywords like "Full Consultant Access," "Guided Option," "Hospital List A/B/C," or "Consultant Select." This tells you the framework you're working within.
- Log in to Your Insurer's Member Portal/App: Most providers have a secure online portal or smartphone app. These usually feature a consultant finder tool tailored to your specific policy level. This is more accurate than the public-facing tool.
- Call Your Insurer's Helpline: This is the most definitive method. Phone your insurer's claims or pre-authorisation department. Have the following information ready:
- Your policy number.
- The full name of the consultant.
- The consultant's speciality (e.g., Orthopaedic Surgeon).
- The name of the hospital or clinic where you plan to see them.
The insurer's agent can give you a concrete "yes" or "no" and confirm their fee status. Always do this before booking an appointment.
Step 3: When You Need a Medical Referral
You cannot simply book a private consultant appointment and expect your insurer to pay. The process must be followed correctly.
- Visit Your GP: Discuss your symptoms. Your GP is the gatekeeper for specialist referrals in the UK, for both NHS and private routes.
- Request a Referral Letter: Explain that you have private medical insurance. Your GP will write you a referral letter. This can be a "named referral" (to Dr. Jane Smith) or an "open referral" (to a consultant gastroenterologist).
- Contact Your Insurer for Pre-Authorisation: This step is non-negotiable. Send your insurer the referral letter and details of your proposed consultant and hospital. They will check your cover and provide a pre-authorisation number if the claim is eligible.
- Book Your Appointment: Only after you have received pre-authorisation should you book your appointment with the consultant. This authorisation is your guarantee that the insurer has agreed to cover the costs, subject to your policy's terms and limits.
Using Provider Tools: A Closer Look at UK Insurers
Each of the best PMI providers has a slightly different system. Here’s a breakdown of the main players in the UK market.
| Provider | Tool Name / Access | Key Features | What it Tells You |
|---|---|---|---|
| AXA Health | Specialist and Hospital Finder | Search by speciality, name, location, or treatment. Filter by gender. | Confirms if the specialist is "fee-approved" by AXA and lists the hospitals where they have practising privileges. |
| Bupa | Consultant and Hospital Finder | Publicly accessible tool. Search by name, speciality, or postcode. | Clearly shows if a consultant is part of the Bupa network. Bupa has different partnership levels, which the tool clarifies. |
| Vitality | Consultant Finder | Often accessed via member portal. Crucial for their "Consultant Select" (guided) option. | Shows if a consultant is part of their "premier" or "partner" network. For guided plans, it will present the specific consultants you can choose from. |
| Aviva | Specialist Finder | Available via the "MyAviva" member portal and on their public website. | Confirms if a specialist is recognised and provides details on the hospitals where they are covered. Distinguishes between standard and "guided" (Expert Select) lists. |
| WPA | Specialist & Hospital Search | Available to members via their online portal. | WPA operates with a list of recognised specialists. The tool confirms recognition and the specific fee schedules they have agreed to. |
Example in Practice:
Let's say your GP refers you to an orthopaedic surgeon for knee pain (an acute condition). You've been recommended Dr. Evans in Manchester.
- Using AXA's tool: You would search for "Dr. Evans," "Orthopaedic Surgery," and "Manchester." The results would show if he is fee-approved and list the AXA-recognised hospitals he works at, for example, The Spire Manchester.
- Using Vitality's "Consultant Select" plan: You would log in, start a claim, and Vitality would offer you a choice of 3-5 approved knee surgeons in the Manchester area from their curated list. Dr. Evans may or may not be on this specific list. If he isn't, you would need to choose one of the other options to be fully covered.
This highlights why understanding your policy type is as important as checking the consultant's name.
What if Your Preferred Consultant Isn't on the List?
Discovering your chosen specialist isn't covered can be disheartening, but you have several options. Don't panic – a solution is usually available.
Option 1: Check Different Hospitals
A consultant's recognition can sometimes be tied to the hospital where they practice. They might be fee-assured at Hospital A but not at Hospital B. Use the insurer's online tools to see all the locations where they practice and check if cover is available at an alternative site.
Option 2: Ask the Consultant's Secretary
Politely contact the consultant's private secretary. Explain your situation and ask two questions:
- Does the consultant have "provider recognition" with your insurer (e.g., Bupa, AXA)?
- If so, are they willing to charge within your insurer's fee schedule for your treatment? Sometimes, a consultant may be willing to become recognised or align their fees, especially if they are trying to build their private practice.
Option 3: Pay the Shortfall
If the consultant is recognised by your insurer but is "non-fee-assured," they will charge more than the insurer's limit.
- Action: Ask your insurer for their maximum benefit for the consultation and any proposed treatment codes.
- Action: Ask the consultant's secretary for a full breakdown of their fees.
- Decision: The difference between these two figures is the "shortfall," which you would pay out-of-pocket. For some, paying a shortfall of, say, £100-£500 for the peace of mind of seeing their top-choice specialist is a worthwhile expense.
Option 4: Choose an Alternative Consultant
If your consultant isn't covered and you don't want to pay a shortfall, your insurer can help. Ask them for a list of 2-3 other highly-regarded, fee-assured specialists in the same field and geographical area. Insurers monitor consultant performance and patient outcomes, so their recommendations are generally excellent.
Option 5: Use the NHS
Remember, your private health cover is an alternative, not a replacement for the NHS. You always have the right to be treated on the NHS at no cost. You can proceed with your private consultation and diagnostics and then transfer back to the NHS for treatment if you wish, or simply use the NHS for the entire pathway.
Option 6: Review Your Policy at Renewal
This is a long-term solution. If access to a specific consultant is a top priority, make a note to address this when your policy is up for renewal. This is where an expert PMI broker like WeCovr adds immense value. We can conduct a full market review to find a policy from a different provider that does include your preferred consultant, ensuring you're prepared for the future.
The Role of a Specialist PMI Broker like WeCovr
Trying to align your medical needs with the complex policy terms of over a dozen insurers can be time-consuming and confusing. A specialist broker works for you, not the insurer, to simplify the entire process.
How WeCovr Helps:
- Market-Wide Checks: Instead of you searching multiple insurer websites, you can give us your consultant's name, and we'll check their status across all major UK providers instantly.
- Policy Matching: We focus on finding a policy that fits you. If a specific consultant is your priority, we'll filter for insurers that include them. If budget is your main concern, we'll find the best-value guided option.
- Explaining the Jargon: We translate confusing terms like "fee-assured," "guided options," and "hospital bands" into plain English, so you can make an informed decision.
- No Extra Cost: Our service is free to you. We are paid a commission by the insurer you choose, which is already built into the premium. You get expert, impartial advice without paying a penny more.
- Added Value: As a WeCovr client, you also get complimentary access to our AI-powered nutrition app, CalorieHero, to support your health goals. Furthermore, customers who buy PMI or life insurance often receive discounts on other types of cover, like home or travel insurance.
Our high customer satisfaction ratings are a testament to our commitment to finding the right cover for our clients' needs and budgets.
Beyond the Consultant: Other Factors Affecting Your Care
Getting your consultant covered is a huge part of the puzzle, but there are a few other elements to keep in mind for seamless private treatment.
- Hospital Lists: Just as insurers have consultant lists, they also have hospital lists. A consultant might be covered, but only when they practise at a hospital that is also on your insurer's list. Most policies have a tiered hospital list, with more comprehensive (and expensive) plans including prime central London hospitals.
- Treatment and Drug Coverage: Even with an approved consultant and hospital, some niche or experimental treatments and drugs may be excluded from cover. Always get pre-authorisation for every stage of your treatment, from diagnostics to surgery and follow-ups.
- Policy Excess and Financial Limits: Your policy will have an excess (the amount you pay towards a claim, e.g., £250) and may have annual financial limits. Be aware of these as they will affect the final cost of your care.
Maintaining Your Health: A Proactive Approach
The best way to manage healthcare costs and needs is to stay healthy. Many modern private medical insurance UK policies actively encourage this, offering rewards and premium discounts for healthy living.
- A Balanced Diet: Focus on a diet rich in whole foods. The NHS Eatwell Guide is an excellent resource, recommending a balance of fruits and vegetables, starchy carbohydrates, proteins, and dairy (or alternatives). Using an app like WeCovr's complimentary CalorieHero can help you track your intake and make healthier choices.
- Regular Physical Activity: The UK Chief Medical Officers recommend adults engage in at least 150 minutes of moderate-intensity activity (like brisk walking or cycling) or 75 minutes of vigorous-intensity activity (like running or tennis) per week.
- Quality Sleep: Aim for 7-9 hours of quality sleep per night. It's crucial for immune function, mental clarity, and physical recovery. Establish a regular sleep schedule and create a restful environment.
- Stress Management: Chronic stress can impact physical health. Incorporate activities like mindfulness, yoga, or simply spending time in nature to manage your stress levels.
By taking a proactive approach to your wellbeing, you not only improve your quality of life but also get more value from your private health cover.
What's the difference between a fee-assured and a non-fee-assured consultant?
Can I add a specific consultant to my insurer's list?
Does my GP referral have to name a specific consultant?
Does private medical insurance cover pre-existing or chronic conditions?
Navigating the world of private healthcare can feel complex, but you don't have to do it alone. At WeCovr, our expert advisors are here to provide clear, personalised advice to help you find the perfect private health cover for your needs and budget.
Contact WeCovr today for a free, no-obligation quote and let us help you secure the peace of mind you deserve.
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
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?
Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
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.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
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.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
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.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
By tapping the button below, you can book a free call with them in less than 30 seconds right now:
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Who Are WeCovr?
WeCovr is an insurance specialist for people valuing their peace of mind and a great service.👍 WeCovr will help you get your private medical insurance, life insurance, critical illness insurance and others in no time thanks to our wonderful super-friendly experts ready to assist you every step of the way.
Just a quick and simple form and an easy conversation with one of our experts and your valuable insurance policy is in place for that needed peace of mind!