Navigating the world of private medical insurance in the UK can feel complex, but WeCovr is here to simplify it. As an FCA-authorised broker that has helped arrange over 800,000 policies, we provide expert guidance to ensure you find the right cover, with the right access to care.
A practical how-to for searching and confirming coverage
You’ve made the smart decision to invest in private health cover. You're ready to bypass long waiting lists and get access to prompt, high-quality medical care. But then comes the crucial question: how do you actually know which hospitals you can use and which specialists will see you?
It’s a question that can cause real anxiety. Choosing the wrong hospital or specialist by mistake could leave you with an unexpected and hefty bill.
This comprehensive guide will demystify the process. We’ll walk you through, step-by-step, how to search, confirm, and confidently use your private medical insurance policy. We will arm you with the knowledge to ensure you’re always treated in the right place, by the right person, at the right time.
Why Hospital and Specialist Lists Are the Bedrock of Your Policy
Think of your private medical insurance policy not as a blank cheque, but as a key to a specific set of doors. These "doors" are the hospitals and specialists your insurer has partnered with. This network is commonly referred to as a hospital list.
Insurers create these lists for one simple reason: to manage costs and ensure quality. They negotiate rates and service level agreements with a select group of private hospitals and medical professionals. By directing their members to this network, they can control their expenses, which in turn helps keep your premiums more affordable.
According to recent data from the Private Healthcare Information Network (PHIN), there are over 500 private hospitals and clinics in the UK. No single insurer covers all of them. Your policy's value is directly tied to the breadth and quality of its specific hospital list. Getting this wrong means you might not be able to use the highly-rated clinic down the road, or you might have to travel further than you’d like for treatment.
Understanding your list is not just a detail; it's fundamental to using your policy effectively.
Understanding the Jargon: Key Terms You Need to Know
The private health insurance market has its own language. Let's translate the most important terms so you can speak it fluently.
- Hospital List/Network: The official list of private hospitals, clinics, and treatment centres your insurer will pay for you to be treated in. This is the most critical element of your policy's practical use.
- Hospital Tier: Insurers often segment their hospital lists into different levels or "tiers". A basic tier might cover a good range of national hospitals, while a premium tier might add access to exclusive, high-cost hospitals, particularly in Central London.
- Specialist/Consultant: A senior doctor who has completed advanced training in a specific area of medicine (e.g., a Cardiologist, an Orthopaedic Surgeon, a Dermatologist). Your GP will refer you to one for diagnosis or treatment.
- Fee-Assured Specialist: This is a specialist who agrees to charge within the fee guidelines set by your insurer. If you see a fee-assured specialist, your insurer will cover their costs in full. If the specialist is not fee-assured, they may charge more than the insurer's limit, leaving you to pay the shortfall.
- Open Referral: This is where your GP refers you to a type of specialist (e.g., "a dermatologist") rather than a named individual. Your insurer then provides you with a list of approved, fee-assured specialists in your area to choose from. This is the most common route.
- Guided Option (or Guided Care): A more restrictive, but often cheaper, version of referral. With a guided option, your insurer will typically give you a shortlist of 2-3 specialists to choose from, rather than a wider list. This reduces your choice but can significantly lower your premium.
- Pre-authorisation: The process of getting your treatment approved by your insurer before you receive it. This is a mandatory step. During pre-authorisation, the insurer confirms that the condition is covered, the treatment is necessary, and your chosen hospital and specialist are on their approved list.
How UK Insurers Structure Their Hospital Lists
Not all hospital lists are created equal. The choice you make when you buy your policy will determine your access to care for years to come. Most major UK PMI providers, such as Bupa, AXA Health, Aviva, and Vitality, use a tiered system.
This allows you to tailor your policy to your location and budget. If you live in rural Scotland, paying extra for premium Central London hospitals probably doesn't make sense. Conversely, if you live or work in the capital, ensuring those facilities are included is vital.
Here’s a typical breakdown of how these tiers work:
| Hospital Tier Level | Typical Coverage | Who It's Best For | Impact on Premium |
|---|
| Standard / Core | A broad network of quality private hospitals across the UK, including groups like Nuffield Health, Spire, and Circle Health. Usually excludes the most expensive Central London hospitals. | The majority of UK residents living outside Central London. Provides excellent national coverage at a competitive price. | Base Premium |
| Extended / Plus | Includes everything in the standard list, plus an additional range of hospitals, often including some more specialised centres or some hospitals inside the M25. | Those who want a wider choice, live in major cities, or want access to specific hospitals not on the standard list. | +10-20% on Base Premium |
| Premium / London | Includes all hospitals from the other tiers, plus the most prestigious and expensive private hospitals in Central London (e.g., The London Clinic, The Lister Hospital, King Edward VII's Hospital). | People who live or work in Central London and want unrestricted access to the top facilities there. | +25-40% on Base Premium |
When choosing a policy, it’s essential to think about:
- Where you live and work: Check for good hospital coverage near both locations.
- Your willingness to travel: Would you be happy to travel 30 miles for treatment, or do you need a hospital within a 5-mile radius?
- Your budget: A premium list costs more every single month. Is the extra access worth the higher premium for you?
An expert PMI broker, like WeCovr, can be invaluable here. We can instantly compare the hospital lists from different insurers against your postcode, helping you find the policy that offers the best local coverage for your budget.
Step-by-Step Guide: How to Find Your Covered Hospitals
Okay, you have your policy. Now, let's find out exactly where you can go. Here is the practical, step-by-step process.
Step 1: Start with Your Policy Documents
Your first port of call should always be the official paperwork. When you took out the policy, you would have received a policy schedule, a policy handbook, and often a separate hospital list document.
- Look for: A section titled "Hospital List," "Hospital Network," or "Directory of Hospitals."
- Check the name: Your documents will state the exact name of your chosen hospital list (e.g., "Key Hospital List," "Expert's Choice Hospitals," "Countrywide Plus"). This name is vital for all future searches.
- Keep it safe: Store these documents, either physically or digitally, where you can find them easily.
Step 2: Use Your Insurer's Online Portal and Hospital Finder
Every major insurer has a digital toolkit for its members. These online portals or apps are the quickest and most up-to-date way to check coverage.
- Log in: Go to your insurer’s website and log in to your member portal.
- Find the Tool: Look for a menu item called "Hospital Finder," "Hospital Search," or something similar.
- Enter Your Details: The tool will usually ask for your postcode, the type of treatment you need (if you know it), and sometimes the name of your specific hospital list from your documents.
- Search and Filter: The results will show a map and a list of covered hospitals near you. You can often filter by distance, hospital group, or specialism.
Pro Tip: Always use the insurer’s official online tool. Hospital lists can and do change. A hospital that was covered last year might not be this year. The online finder is always the most current source of truth.
Step 3: Pick Up the Phone and Call Your Insurer
Sometimes, you just need to speak to a human. If you're unsure about anything, or if you're planning a specific procedure, calling your insurer’s helpline is a brilliant way to get clear confirmation.
- Have your policy number ready.
- Be specific: Tell them, "I need an MRI scan. I live in Bristol. Can you tell me which hospitals on my list near me offer this service?"
- Get pre-authorisation: If your GP has already referred you for treatment, this is the perfect time to start the pre-authorisation process. The call handler will confirm your cover, the hospital, the specialist, and give you an authorisation code.
Step 4: Ask the Professionals: Your GP and Specialist
Your GP and your chosen specialist are experienced in dealing with private medical insurance.
- Your GP: When your GP refers you, they may know which local private hospitals are generally covered by major insurers. However, they won't know the specifics of your policy, so don't rely on their advice alone.
- Your Specialist's Secretary: Once you have a specialist in mind, their private secretary is an incredibly valuable resource. When you call to book a consultation, ask them: "Do you know if Dr. Smith is recognised by [Your Insurer's Name] and does he have practicing privileges at [Your Chosen Hospital]?" They deal with this all day, every day.
How to Find and Confirm a Covered Specialist
Finding a hospital is only half the battle. You also need to ensure the specialist treating you is approved by your insurer. The goal is to find a fee-assured specialist to avoid any payment shortfalls.
Here's how to do it:
- Start with an Open Referral: Ask your GP to write a referral letter addressed to a "Consultant Cardiologist," for example, rather than "Dr. Jane Evans." This gives you and your insurer maximum flexibility.
- Use the Insurer's Specialist Finder: Just like the hospital finder, most insurers have an online tool to find recognised specialists. You can log in to your portal and search by specialism (e.g., Orthopaedics) and location. The list provided will consist of specialists who are registered with the insurer.
- Check for "Fee-Assured" Status: The online search results will often indicate whether a specialist is fee-assured. Some insurers even have a "fee-assured" filter you can apply. This is the gold standard.
- Call the Insurer for a List: If you have an open referral, you can call your insurer and say, "My GP has referred me to a dermatologist in the Leeds area. Could you please provide me with a list of fee-assured specialists I can choose from?" They will then send you a list to contact.
- Confirm with the Specialist's Secretary: When you call to book your first appointment, confirm two things:
- "Is the consultant recognised by [Your Insurer]?"
- "Will you be billing within [Your Insurer's] fee guidelines?" (This is a polite way of asking if they are fee-assured for the proposed treatment).
What If My Preferred Specialist Isn't Fee-Assured?
This can happen. A highly sought-after specialist may decide to charge more than insurers are willing to pay. If you are set on seeing them, you have two options:
- Negotiate: Sometimes, the specialist may be willing to accept the insurer's fee if you ask.
- Pay the Shortfall: You will have to pay the difference between the specialist's total bill and what your insurer pays out. Your insurer will tell you the maximum they will contribute for a given procedure. For example:
- Specialist's Fee: £400
- Insurer's Guideline Fee: £250
- Your Shortfall to Pay: £150
You must be pre-authorised for this and agree to the shortfall in writing with your insurer.
Real-Life Scenarios: Putting Your Knowledge to the Test
Let's see how this works in practice.
Scenario 1: Sarah in Manchester
- Problem: Sarah has developed persistent knee pain and her GP suspects a torn meniscus. She has a standard private health cover policy with Aviva.
- Action Plan:
- Sarah's GP writes an open referral to an "Orthopaedic Surgeon specialising in knees."
- Sarah logs into her MyAviva portal and uses the hospital finder. She confirms her policy is on the "Key" hospital list. She sees that the Spire Manchester Hospital and The Alexandra Hospital are both covered and close by.
- She then uses the specialist finder for fee-assured orthopaedic surgeons who practice at Spire Manchester. She finds three options.
- She calls Aviva to get pre-authorisation. They confirm her condition is covered and give her an authorisation code.
- She calls the secretary of her chosen specialist, gives the authorisation code, and books her initial consultation, confident that everything is covered.
Scenario 2: David in London
- Problem: David needs to see a dermatologist for a worrying mole. He has a premium policy with Bupa that includes the "London Hospitals" upgrade. He wants to see a specific, highly recommended doctor at The Lister Hospital.
- Action Plan:
- David checks his Bupa documents and confirms The Lister is on his hospital list.
- He gets a referral from his GP, but it's a named referral to the specific doctor he wants to see.
- He calls Bupa for pre-authorisation. The Bupa agent informs him that while the hospital is covered, the specific doctor he has chosen is not fee-assured and his consultation fees are £100 higher than Bupa's guidelines.
- David has a choice:
- Option A: Ask Bupa for a list of fee-assured dermatologists who practice at The Lister.
- Option B: Proceed with his chosen doctor and agree to pay the £100 shortfall himself.
- Deciding the peace of mind is worth it, David chooses Option B and confirms this with Bupa. He is now fully informed and avoids any surprise bills.
A Critical Reminder: What Standard PMI Does Not Cover
It is vital to remember the core purpose of private medical insurance in the UK. It is designed to cover acute conditions that arise after you take out your policy.
Standard UK PMI policies DO NOT cover:
- Pre-existing conditions: Any illness, injury, or symptom you had before your policy started.
- Chronic conditions: Long-term conditions that cannot be cured, only managed, such as diabetes, asthma, or high blood pressure. PMI may cover the initial diagnosis of a chronic condition, but it will not cover the day-to-day monitoring or ongoing management.
This is a fundamental principle of the UK market. Always be transparent about your medical history when applying for cover.
The WeCovr Advantage: Making Sense of It All
Feeling a bit overwhelmed? That's completely normal. This is precisely why working with an expert, independent broker is so beneficial.
At WeCovr, we don't just sell you a policy; we partner with you for the long term.
- Comparing Apples with Apples: We have access to the detailed hospital lists from all the UK's leading insurers. Before you even sign up, we can compare them based on your postcode and personal preferences, ensuring you get the best possible access for your money.
- No Jargon, Just Clear Advice: Our friendly, expert advisors speak your language. We explain the difference between guided options and open referrals, and help you decide which is right for you. We take the time to understand your needs.
- Exclusive Benefits: When you arrange your PMI policy through WeCovr, you get more than just insurance. You also receive:
- Complimentary access to CalorieHero: Our AI-powered calorie and nutrition tracking app to help you stay on top of your health goals.
- Exclusive discounts: On other insurance products like life or home insurance, saving you more money.
- High Customer Satisfaction: Our commitment to clear, honest advice and ongoing support is reflected in our consistently high customer satisfaction ratings.
Choosing an insurer is a big decision. Let us do the heavy lifting for you, at no cost to you.
What happens if I use a hospital or specialist that isn't on my insurer's list?
Generally, if you use a non-approved hospital or specialist without prior agreement from your insurer, they will not cover the costs. You would be responsible for paying the entire bill yourself. This is why getting pre-authorisation before any consultation or treatment is absolutely essential. In very rare circumstances (for example, a medical emergency where there are no approved facilities nearby), an insurer might make an exception, but you cannot rely on this.
Can my insurer change the hospital list during my policy year?
Yes, insurers reserve the right to change their hospital networks. This usually happens at your annual renewal, but changes can technically happen at any time as commercial agreements between insurers and hospital groups evolve. A hospital might be added or removed from a list. This is why you should always use the insurer's live online hospital finder tool before starting any new course of treatment, rather than relying on a printed list from a year ago.
Do I need to check the list every single time I use my policy?
Yes, you do, as part of the pre-authorisation process. For each new claim or course of treatment, you must contact your insurer to get it approved. During this call or online process, they will confirm that your chosen hospital and specialist are covered for that specific treatment. This simple step protects you from unexpected costs and ensures your claim is handled smoothly.
Does the hospital list affect the cost of my private medical insurance?
Absolutely. The hospital list you choose is one of the biggest factors affecting your premium. A policy with a limited, "core" list of hospitals will be significantly cheaper than a policy with a comprehensive list that includes premium private hospitals in Central London. Tailoring your hospital list to your likely needs and location is one of the best ways to control the cost of your cover.
Your health is your most valuable asset. Your private medical insurance is the key to protecting it. By understanding how to check your hospital and specialist cover, you empower yourself to use your policy with confidence and get the maximum value from your investment.
Ready to find the perfect private medical insurance UK policy with the right hospital access for you? Speak to one of our friendly, expert advisors today. Get your free, no-obligation quote from WeCovr and experience the peace of mind that comes with being properly covered.