Your Rights as a Private Patient in the UK
As an FCA-authorised broker that has helped arrange over 800,000 policies, WeCovr understands that choosing private medical insurance in the UK is a significant decision. While the NHS is a national treasure, millions are now looking to private healthcare for faster access to specialists and greater choice over their treatment. But what happens once you go private? What are your rights, and who protects you? This guide explains everything you need to know.
WeCovr explains what protections and rights private patients have
Deciding to use private healthcare, whether through insurance or self-funding, means entering a new system with its own rules and standards. The good news is that you are protected by a robust framework of regulators and consumer rights designed to ensure your care is safe, transparent, and of high quality.
Your rights as a private patient span everything from choosing your doctor and hospital to consenting to treatment, accessing your medical records, and knowing exactly what you're paying for. This article will walk you through each of these rights, explain the role of the organisations that protect you, and show you how to navigate the private healthcare journey with confidence.
The Foundation of Your Rights: The UK Regulatory Framework
You are not on your own when you use private healthcare. A network of independent bodies works to ensure that both your insurance policy and your medical treatment meet high standards. Understanding who they are is the first step to feeling secure in your choices.
Key Regulators Protecting Private Patients
| Regulator | What They Do | Why It Matters to You |
|---|---|---|
| Care Quality Commission (CQC) | Inspects and rates hospitals, clinics, and care services in England. | You can check a hospital's CQC rating for safety, effectiveness, and care quality before you choose where to have your treatment. |
| Financial Conduct Authority (FCA) | Regulates the sale and administration of insurance policies. | Ensures your insurance policy is sold fairly and that brokers, like WeCovr, act in your best interests. It protects you from misleading information. |
| General Medical Council (GMC) | Maintains the official register of all doctors practising in the UK. | You can verify your consultant's qualifications and check they are fit to practise medicine. |
| Independent Sector Complaints Adjudication Service (ISCAS) | Handles unresolved complaints about private healthcare providers. | If you have a problem with your care and can't resolve it with the hospital, ISCAS provides a free, independent review. |
| Financial Ombudsman Service (FOS) | Settles disputes between consumers and financial services firms, including insurers. | If you have an issue with your insurer (e.g., a rejected claim) that you can't resolve, the FOS can step in to make a final decision. |
In the other UK nations, similar bodies to the CQC oversee healthcare quality:
- Scotland: Healthcare Improvement Scotland (HIS)
- Wales: Healthcare Inspectorate Wales (HIW)
- Northern Ireland: The Regulation and Quality Improvement Authority (RQIA)
These organisations form a safety net, ensuring that from the moment you buy your policy to the final follow-up appointment, your rights are upheld.
Your Core Rights as a Private Patient: What You Can Expect
When you become a private patient, you are empowered with several fundamental rights. These are not just nice-to-haves; they are the cornerstones of high-quality private care.
1. The Right to Choose
This is one of the primary reasons people opt for private healthcare. Your right to choose includes:
- Choice of Consultant: You can select a specific specialist or surgeon, often based on their reputation or area of expertise.
- Choice of Hospital: Your policy will include a list of approved hospitals. You can choose from this list, selecting a facility that is convenient for you or known for excellence in a particular field.
- Choice of Timing: You have the flexibility to schedule appointments and procedures at times that suit you, helping you fit treatment around work and family commitments.
2. The Right to Informed Consent
Before any treatment begins, you must give your informed consent. This is more than just a signature on a form. It means your consultant must clearly explain:
- Your diagnosis.
- The recommended treatment and what it involves.
- The potential benefits and risks of the procedure.
- Any alternative treatment options, including the option to do nothing or use the NHS.
- The expected costs associated with the treatment.
Real-Life Example: Imagine you need a hip replacement. Your consultant should discuss the success rate of the surgery, the typical recovery period, the specific risks like infection or blood clots, and alternative options like physiotherapy or pain management injections. You have the right to ask as many questions as you need to feel completely comfortable before proceeding.
3. The Right to Transparency and Information
You have a right to be fully informed about your care and its costs.
- Access to Medical Records: You have the right to request and receive copies of your medical records from the private hospital or clinic.
- Clear Pricing: The hospital and consultant must provide you with a clear breakdown of costs before treatment starts. For self-funded patients, this is usually a fixed-price package. For insured patients, this ensures you know what your policy covers and if there might be any shortfalls.
- Quality Information: You can access information on your hospital's CQC rating and your consultant's performance data, where available.
4. The Right to Quality and Safety
Every patient has the right to be treated in a safe, clean environment by qualified professionals. This is non-negotiable and is enforced by the regulators mentioned earlier.
- Safe Environment: Hospitals must meet strict hygiene and safety standards to minimise risks like healthcare-associated infections.
- Qualified Staff: Every doctor must be registered with the GMC, and nurses with the Nursing and Midwifery Council (NMC).
5. The Right to Complain
If you are unhappy with any aspect of your care, you have the right to make a complaint and have it taken seriously. The process should be straightforward, and if you are not satisfied with the provider's response, you have the right to escalate your complaint to an independent body like ISCAS.
Understanding Your Private Medical Insurance Policy: The Contract is Key
Your private medical insurance policy is a contract between you and your insurer. Your rights to treatment are defined by the terms of this contract. It is vital to understand what it does—and does not—cover.
Critical Information: Pre-existing and Chronic Conditions
This is the most important limitation to understand about standard private medical insurance in the UK. These policies are designed to cover acute conditions that arise after your policy has started.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include appendicitis, cataracts, broken bones, or the need for a joint replacement.
- Chronic Condition: An illness that cannot be cured, only managed. It is long-term and ongoing. Examples include diabetes, asthma, high blood pressure, and Crohn's disease. Standard PMI does not cover the routine management of chronic conditions.
- Pre-existing Condition: Any medical condition for which you have experienced symptoms, received medication, or sought advice from a medical professional in the years leading up to your policy start date (typically the last 5 years).
| Condition Type | Covered by Standard UK PMI? | Example |
|---|---|---|
| New Acute Condition | Yes | You develop gallstones a year after taking out your policy and need surgery. |
| Chronic Condition | No | You need regular check-ups and medication to manage your type 2 diabetes. |
| Pre-existing Condition | No (with exceptions) | You had knee pain and saw a physio for it 3 years before buying your policy. |
How Pre-existing Conditions Are Handled: Underwriting
Insurers use a process called underwriting to decide how to handle pre-existing conditions.
- Moratorium Underwriting: This is the most common type. You don't complete a medical questionnaire. Instead, the insurer automatically excludes any condition you've had in the last 5 years. However, if you remain treatment-free and symptom-free for that condition for a continuous 2-year period after your policy starts, the insurer may then cover it.
- Full Medical Underwriting (FMU): You declare your entire medical history on an application form. The insurer assesses it and gives you a clear list of what is permanently excluded from cover from day one. This provides certainty but can lead to more initial exclusions.
An expert PMI broker like WeCovr can help you navigate these options, ensuring you choose the underwriting method that best suits your personal circumstances at no extra cost to you.
The Private Patient Pathway: A Step-by-Step Guide to Using Your Cover
Knowing your rights is one thing; using your policy effectively is another. Follow these steps to ensure a smooth journey.
- Visit Your GP: Your journey almost always starts with your GP. Even with PMI, you will likely need a GP referral to see a private specialist. Many policies include access to a 24/7 digital GP service, which can be a convenient first step.
- Contact Your Insurer for Pre-authorisation: This is a crucial step. Before you book any consultations or treatment, you must call your insurer. Tell them about your GP's referral and the proposed treatment. They will check your cover and issue a pre-authorisation number. Without this, they may refuse to pay the claim.
- Choose Your Specialist and Hospital: Using your insurer's approved list, you can now choose your consultant and the hospital where you'd like to be treated. Your insurer can often provide you with a list of specialists in your area.
- Book Your Appointment: When booking your consultation, give the hospital or clinic your pre-authorisation number and policy details.
- Undergo Treatment: The hospital and your specialist will usually send their bills directly to your insurer, making the process seamless for you.
- Settle Any Shortfalls: Be aware of two potential costs you may need to cover:
- Excess: This is the fixed amount you agreed to pay towards any claim when you took out the policy. You will pay this directly to the hospital.
- Shortfall: This occurs if your consultant's fees are higher than the amount your insurer has agreed to pay for that procedure. Insurers publish fee guidelines, and most consultants stick to them, but it's always wise to confirm this with the consultant's secretary beforehand.
Example Cost Breakdown
| Cost Component | Paid by Insurer? | Paid by You? | Notes |
|---|---|---|---|
| Hospital Bill (e.g., room, nursing) | Yes (fully, if pre-authorised) | - | Billed directly to the insurer. |
| Consultant Fees | Up to policy limits | Any shortfall above the limit. | Always check fee-assurance with your consultant. |
| Policy Excess | No | Yes | A one-off payment per claim or per year. |
| Outpatient Scans & Tests | Up to your outpatient limit | Any costs over the limit. | Check your policy documents for your outpatient cover level. |
What Happens When Things Go Wrong? Your Right to Complain
Even in the best systems, problems can occur. Whether your issue is with the quality of your medical care or a decision made by your insurer, there is a clear path to resolution.
Complaining About Your Medical Care
- Complain to the Provider First: The first step is to raise your concern directly with the hospital or clinic. Most have a designated complaints manager or a Patient Advice and Liaison Service (PALS). Put your complaint in writing, keeping a clear record of who you spoke to and when.
- Escalate to ISCAS: If you are not happy with the provider's final response, you can take your case to the Independent Sector Complaints Adjudication Service (ISCAS). This is a free, independent service that will review your case. This is your primary route for complaints about private clinical care.
Complaining About Your Insurance Provider
- Complain to the Insurer First: If your dispute is about your insurance policy—for example, a claim has been rejected or you feel you were misled—you must first make a formal complaint to the insurer. They have up to eight weeks to provide a final response.
- Escalate to the Financial Ombudsman Service (FOS): If you are dissatisfied with the insurer's final response, or if they fail to respond within eight weeks, you can escalate your complaint to the Financial Ombudsman Service (FOS). The FOS is an impartial and free service that has the power to force the insurer to pay a claim or offer you compensation.
Beyond Treatment: Wellness Benefits and Modern PMI Perks
Today's best private medical insurance policies offer more than just access to treatment when you're ill. They actively support your health and wellbeing.
Many leading insurers now include a range of preventative benefits designed to keep you healthy:
- 24/7 Digital GP Access: Speak to a GP by phone or video call anytime, anywhere, often with same-day appointments available.
- Mental Health Support: Access to telephone counselling, therapy sessions, or mental health apps without needing a GP referral.
- Wellness and Lifestyle Rewards: Get discounts on gym memberships, fitness trackers, healthy food, and even cinema tickets for staying active.
At WeCovr, we believe in proactive health. That’s why all our health and life insurance clients receive complimentary access to CalorieHero, our exclusive AI-powered calorie and nutrition tracking app. We also offer our clients discounts on other types of cover, such as travel or home insurance, as a thank you for trusting us with their health.
The UK Private Healthcare Market: Facts and Figures for 2025
The shift towards private healthcare is a significant trend in the UK, driven by a desire for faster access and more choice.
- Growing Demand: According to the Office for National Statistics (ONS) and industry analysts like LaingBuisson, around 11-12% of the UK population has some form of private health cover.
- NHS Waiting Times: A key driver for this demand is the pressure on the NHS. In early 2024, the NHS England waiting list stood at over 7.5 million treatment pathways. For many, private medical insurance is a way to bypass these queues for eligible conditions.
- High Quality of Care: Confidence in the private sector is high. The latest CQC data shows that a vast majority of independent hospitals in England are rated as 'Good' or 'Outstanding', reflecting high standards of patient safety and care.
These statistics paint a clear picture: private healthcare is a well-established and highly regulated part of the UK's health landscape, offering a valuable alternative for those who seek it.
Do my private healthcare rights differ from my NHS rights?
What happens if my private treatment goes wrong and I need emergency NHS care?
Can my private medical insurance provider refuse a treatment my consultant recommends?
Take the Next Step with WeCovr
Navigating your rights and finding the right private health cover can feel complex, but you don't have to do it alone. At WeCovr, our team of friendly, expert advisors is here to help.
As an FCA-authorised PMI broker, we compare policies from the UK's most trusted insurers to find cover that fits your needs and budget. Our advice is independent, and our service is free.
Ready to take control of your healthcare? Get your free, no-obligation private medical insurance quote from WeCovr today and discover a smarter way to protect your health.
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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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!