Private Health Insurance for Fractures and Broken Bones UK
A sudden fall, a sports injury, an unfortunate accident – a broken bone can happen to anyone. When it does, your top priority is getting the best care, fast. As an FCA-authorised broker that has helped arrange over 800,000 policies, WeCovr understands that navigating treatment options can be daunting. This guide explores how private medical insurance in the UK can provide a crucial safety net for fractures and broken bones.
How PMI supports faster orthopaedic care after accidents
Private Medical Insurance (PMI) is designed to work alongside the NHS, offering you more choice, comfort, and, most importantly, speed when you need non-emergency treatment. For an acute injury like a fracture, this means bypassing lengthy NHS waiting lists for specialist consultations, diagnostic scans, and surgery.
While the NHS provides excellent emergency care, the subsequent journey to full recovery can be slow. According to the latest NHS England data, the waiting list for trauma and orthopaedic treatment – the speciality that deals with bones and joints – remains one of the largest, with hundreds of thousands of patients waiting for procedures.
With PMI, once you are stabilised by the NHS in A&E, you can activate your policy. This unlocks a parallel pathway to private care, enabling you to see a leading orthopaedic consultant within days, not weeks or months. This rapid access to expert care is the single biggest advantage of having private health cover for fractures.
The Patient Journey: NHS vs. Private Care for a Broken Bone
To truly understand the value of PMI, let's walk through a common scenario: a 45-year-old amateur cyclist who falls and suffers a complex wrist fracture.
Step 1: The Accident and Initial A&E Visit
This step is the same for everyone, regardless of insurance.
- NHS & Private: The cyclist goes straight to the nearest NHS Accident & Emergency department. This is essential, as PMI does not cover initial emergency treatment. A&E staff will assess the injury, provide pain relief, and perform an initial X-ray. They will stabilise the fracture, perhaps in a temporary splint or cast, and advise on the next steps.
Step 2: The Referral and Consultation (The Key Difference)
This is where the two paths diverge significantly.
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The NHS Pathway: The A&E team refers the patient to their local NHS fracture clinic. They may face a wait of several days to a week for this appointment. At the clinic, they will see an orthopaedic specialist, but it might not be a consultant. If surgery is deemed necessary, they are placed on the NHS waiting list. As of early 2025, waiting times for elective orthopaedic surgery can stretch from several weeks to many months.
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The Private Pathway: After the A&E visit, the patient calls their PMI provider to open a claim. They provide the details of the injury and the A&E report. The insurer authorises a consultation. The patient then gets a GP referral (many PMI policies now offer a Digital GP service for instant referrals) and can book an appointment with a consultant orthopaedic surgeon of their choice from the insurer's approved list, often within 24-72 hours.
Step 3: Diagnostic Scans
Advanced imaging is often needed to plan surgery.
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The NHS Pathway: If the consultant needs an MRI or CT scan to get a better view of the fracture, the patient is added to the NHS waiting list for diagnostics. This can add further delays of several weeks.
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The Private Pathway: The private consultant can schedule an MRI or CT scan at a private hospital or scanning facility, usually within a few days. The results are available quickly, allowing the treatment plan to be finalised without delay.
Step 4: Surgery and Hospital Stay
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The NHS Pathway: The patient waits their turn on the surgical list. The date can be unpredictable and subject to change if more urgent cases come in. They will be treated in an NHS hospital, likely on a general orthopaedic ward.
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The Private Pathway: Surgery is booked at a time convenient for both the patient and the surgeon, typically within a week or two of the consultation. The procedure takes place in a private hospital, which usually offers a private room with an en-suite bathroom, better food choices, and more flexible visiting hours.
Step 5: Rehabilitation and Physiotherapy
Recovery is just as important as the initial treatment.
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The NHS Pathway: Post-surgery physiotherapy is provided by the NHS. While effective, the number of sessions may be limited, and there can be waiting lists to start treatment. Group sessions are also common.
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The Private Pathway: Most comprehensive PMI policies include a set number of post-operative physiotherapy sessions. These are one-to-one with a private physiotherapist, starting promptly after surgery to ensure the best possible recovery outcome.
NHS vs. Private Care Journey for a Fracture: A Summary
| Stage of Care | NHS Pathway | Private Medical Insurance Pathway |
|---|---|---|
| Initial Emergency | A&E visit (covered by NHS) | A&E visit (covered by NHS) |
| Specialist Referral | Referral to NHS fracture clinic. Wait of days/weeks. | GP referral to private consultant. Appointment within days. |
| Diagnostics (MRI/CT) | Added to NHS waiting list. Wait of weeks. | Scans performed within days at a private facility. |
| Surgery (if needed) | Added to NHS surgical waiting list. Wait of weeks/months. | Surgery scheduled promptly at a private hospital. |
| Hospital Stay | NHS ward, potentially shared with other patients. | Private en-suite room. |
| Rehabilitation | NHS physiotherapy, potential waits and group sessions. | Prompt, one-to-one private physiotherapy sessions. |
The Crucial Distinction: Acute vs. Chronic Conditions
This is the single most important concept to understand about private medical insurance in the UK.
PMI is designed exclusively for acute conditions.
An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. It has a sudden onset, a short duration, and is not expected to last for the long term.
- Example: A broken arm from a fall. With treatment (a cast or surgery), it will heal, and you will recover. This is a classic acute condition that PMI is designed to cover.
A chronic condition, on the other hand, is an illness or disease that continues for a long time. It cannot be cured, only managed.
- Example: Osteoporosis. This is a long-term condition that weakens bones, making them more likely to break. Standard PMI policies will not cover the ongoing management of osteoporosis itself (e.g., medication, regular check-ups). However, if you break a bone because of your osteoporosis, the fracture itself is still an acute event and may be covered, but the underlying chronic cause is not.
Why is this important? Insurers will not cover treatment for conditions you already have when you take out a policy (pre-existing conditions) or those that require long-term management (chronic conditions). This is how they keep premiums affordable. A fracture or broken bone that occurs after your policy starts is a new, acute condition and is therefore eligible for cover.
Understanding What PMI Covers for Fractures
A comprehensive private health insurance policy provides end-to-end cover for the private treatment of a broken bone. Here’s what is typically included, assuming the injury is a new, acute condition.
1. Specialist Consultations:
- Initial and follow-up appointments with a consultant orthopaedic surgeon.
2. Diagnostic Tests and Scans:
- Advanced imaging like MRI, CT, and PET scans to accurately assess the fracture.
- X-rays and blood tests.
- This is often part of the 'out-patient' cover limit on your policy, so it's vital to choose a plan with adequate cover.
3. Hospital and Surgical Fees:
- Costs for your stay in a private hospital.
- Surgeon's and anaesthetist's fees for the operation.
- The cost of the operating theatre.
4. In-patient and Day-patient Treatment:
- This covers the surgery itself, whether you need to stay overnight (in-patient) or are treated and discharged the same day (day-patient).
- It also includes the cost of any prosthetics used, such as metal plates, screws, or rods needed to fix the bone.
5. Post-operative Care and Rehabilitation:
- Follow-up care from your consultant.
- A set number of physiotherapy sessions to restore movement and strength.
- In some cases, home nursing may be covered for a short period after you are discharged.
6. Mental Health Support:
- Many top-tier policies now include access to mental health support, which can be invaluable for dealing with the psychological impact of a serious injury and a long recovery.
What's Typically Not Covered by UK PMI for Fractures?
It's equally important to know the limitations of your cover to avoid any surprises.
- Emergency Services: Your initial trip to A&E is always handled by the NHS. PMI is for planned, non-emergency care.
- Pre-existing Conditions: If you have a history of problems with a specific bone or joint before taking out your policy, treatment for a new fracture in that same area might be excluded. This depends on your policy's underwriting.
- Chronic Conditions: As explained above, the long-term management of conditions that weaken bones, like osteoporosis or certain types of arthritis, is not covered.
- Injuries from "Hazardous" Activities: Standard policies often exclude injuries sustained during professional sports, motorsports, or activities deemed particularly risky (e.g., mountaineering, hang-gliding). You may need specialist cover if you participate in these hobbies. Always check the policy wording.
- Cosmetic Surgery: Any procedures deemed purely cosmetic, rather than medically necessary for restoring function, will not be covered.
Choosing the Right Private Medical Insurance for Orthopaedic Cover
With so many options, choosing the best PMI provider can feel overwhelming. A specialist broker like WeCovr can be invaluable, comparing policies from across the market to find the one that best suits your needs and budget, at no extra cost to you.
Here are the key factors to consider:
1. Level of Out-patient Cover
This is crucial for fracture care. Out-patient cover pays for your initial consultant appointments and diagnostic scans before you are admitted for surgery. A policy with a low out-patient limit (e.g., £500) might not be enough to cover a consultation and an MRI scan, meaning you'd have to pay the shortfall. For comprehensive orthopaedic cover, a policy with full out-patient cover is ideal.
2. Hospital List
Insurers have different lists of approved hospitals. If you want to be treated at a specific private hospital near you, check that it is included in your chosen policy's list. More comprehensive (and expensive) plans offer a wider choice of hospitals, including premium central London facilities.
3. Policy Excess
This is the amount you agree to pay towards any claim. A higher excess (£500 or £1,000) will lower your monthly premium, but you'll have to pay that amount if you need to use the policy. A lower excess (£100 or £250) means higher premiums.
4. Underwriting Type
- Moratorium Underwriting: This is the most common type. The insurer does not ask for your full medical history upfront. Instead, they will generally exclude treatment for any condition you've had symptoms of, or received treatment for, in the five years before your policy started. However, if you remain symptom-free and treatment-free for that condition for two continuous years after your policy begins, it may become eligible for cover.
- Full Medical Underwriting (FMU): You provide your full medical history when you apply. The insurer then tells you upfront exactly what is and isn't covered. This provides more certainty but can be a more involved process.
Major UK PMI Provider Comparison
| Provider | Key Orthopaedic Strengths | Potential Drawbacks |
|---|---|---|
| AXA Health | Strong hospital network, excellent 'Personalised Case Management' for complex claims. | Premiums can be at the higher end. |
| Bupa | Extensive network of consultants and hospitals, 'Bupa Direct Access' for fast physio and mental health support without a GP referral. | Can be more expensive, especially for older applicants. |
| Aviva | 'Expert Select' hospital list offers good value, strong digital GP service. | The standard hospital list can be more restrictive than competitors. |
| Vitality | Focus on wellness, rewarding healthy living with premium discounts and other perks. Can encourage bone-strengthening activity. | The rewards programme can be complex to maximise. |
| The Exeter | Known for flexible underwriting and considering applicants with some pre-existing conditions. | Smaller hospital network compared to the major players. |
How Much Does PMI for Fracture Cover Cost?
The cost of private medical insurance in the UK varies widely based on several factors:
- Age: Premiums increase as you get older.
- Location: Costs are generally higher in London and the South East due to more expensive private hospital fees.
- Level of Cover: A comprehensive plan with full out-patient cover and a national hospital list will cost more than a basic plan.
- Excess: A higher excess reduces your premium.
- Smoker Status: Non-smokers pay less.
Here are some illustrative monthly premium estimates for a comprehensive policy with £500 excess and full out-patient cover.
| Age | Location: Manchester | Location: London |
|---|---|---|
| 30-year-old | £55 - £75 | £70 - £90 |
| 45-year-old | £80 - £110 | £100 - £135 |
| 60-year-old | £140 - £190 | £170 - £230 |
Disclaimer: These are guide prices only for 2025. Your actual quote will depend on your individual circumstances and the insurer you choose.
Beyond Treatment: Wellness Benefits and Fracture Prevention
The best way to deal with a fracture is to prevent it from happening in the first place. Modern PMI is increasingly focused on proactive health and wellness.
Diet for Bone Health: Your bones need a constant supply of key nutrients.
- Calcium: Found in dairy products (milk, cheese, yoghurt), leafy green vegetables (kale, broccoli), and fortified foods.
- Vitamin D: Crucial for absorbing calcium. Our main source is sunlight on the skin. In the UK, especially during autumn and winter, a supplement is recommended. It's also found in oily fish, red meat, and egg yolks.
Exercise for Strong Bones: Weight-bearing and resistance exercises are essential for building and maintaining bone density.
- Weight-bearing: Brisk walking, running, dancing, tennis.
- Resistance: Lifting weights, using resistance bands, or bodyweight exercises like push-ups and squats.
- Balance: Activities like yoga, Pilates, and Tai Chi can improve balance and coordination, reducing the risk of falls, especially as we age.
Many PMI providers, notably Vitality, actively encourage this by tracking your activity and rewarding you with discounts and perks. At WeCovr, we support our clients' health journeys by providing complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, helping you monitor your intake of vital nutrients like calcium.
The WeCovr Advantage: More Than Just a Policy
Choosing private medical insurance is a significant decision. At WeCovr, we believe in making the process simple, transparent, and tailored to you. Our high customer satisfaction ratings reflect our commitment to putting clients first.
Here's how we help:
- Expert, Impartial Advice: As an FCA-authorised broker, we are not tied to any single insurer. Our experts provide unbiased advice focused solely on finding the right cover for you.
- Whole-of-Market Comparison: We compare policies from all the leading UK insurers, saving you the time and hassle of getting multiple quotes yourself.
- No Cost to You: Our service is completely free. We are paid a commission by the insurer you choose, but this does not affect the premium you pay.
- Added Value: All our PMI and Life Insurance clients receive complimentary access to our CalorieHero app to support their health goals. Plus, you can benefit from exclusive discounts on other types of cover you might need, such as life or home insurance.
A fracture or broken bone is a serious disruption to your life. Having the right private medical insurance in place provides the peace of mind that you can access expert care quickly, giving you the best chance of a swift and complete recovery.
Can I get private health insurance if I've broken a bone before?
Does private medical insurance UK cover physiotherapy for a fracture?
Will my PMI cover a fracture from a ski trip abroad?
Ready to find the right protection for you and your family? Get a free, no-obligation quote from a WeCovr expert today and discover how affordable peace of mind can be.
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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