When is it best to use your private health cover, when the NHS?

The NHS provides a valuable alternative to using your private policy. You can be safe in the knowledge you’ll receive the same high standard of care, as all private doctors are required to hold an additional NHS post. So in what circumstances is it best to consider using the NHS over your insurance policy? And in what situations would it be be preferential to go private?

The NHS route

The following factors could make it beneficial for you to have your treatment on the NHS:

  • Short NHS waiting list – If your main motivation for taking out private medical insurance is to avoid a long wait on the NHS, then if you can be seen quickly it might make sense to go down this route instead. With 6 week rule policies you need to use the NHS anyway for in/day patient treatment or tests available within a 6 week period. If you know you can be seen quickly, save yourself the time and hassle of going through the claims process and opt for the NHS route straight away.

  • Policies with a NCD – If your policy comes with a no claims discount, for low value claims you could be best settling these yourself or going through the NHS. The additional increase in the cost of your policy next year from losing your no claims discount may make it worthwhile for you to pay for the treatment yourself, rather than submitting the invoices to your insurer.

    Remember, you can still call your insurer and get your claim assessed, so if does turn out to be something more complex it will still be covered. Even though you’ve called your insurer and had a claim approved, your no claims discount won’t be impacted until they’ve settled the invoices.

  • Policies with an excess – If you’ve got a hefty excess on your policy and aren’t in the position to pay it at the moment, going down the NHS route could be your only option. If you’re finding it difficult to pay your excess, you can reduce or remove this option at the end of the policy year.

  • Sometimes the NHS is better equipped – The NHS is the best place for you in the case of emergency or trauma. Private hospitals aren’t generally used to dealing with these kind of cases and you’ll receive superior treatment on the NHS.

  • Claims for children – While private paediatricians are available, many private hospitals refuse to allow children under 12 an admission. As children get preferential treatment on the NHS you can be safe in the knowledge your child will be getting the highest level of care as quickly as possible.

  • NHS cash benefit – Many policies offer you a cash incentive to use the NHS, so if you don’t mind the lesser facilities this could give your finances a valuable cash boost. Bear in mind though that you insurer won’t usually cover you for the first few nights of any unplanned or emergency admissions.

When is it best to go private?

  • Long waiting lists – Although the NHS will try and fit you in under 18 weeks for an appointment, there are times when you just don’t want to wait that long. For some orthopaedic appointments you’ll be waiting much longer than this, so it makes sense to use your policy – after all, there’s a reason you’ve been paying for it all this time!

  • Expensive drugs not available on the NHS – Private hospitals have access to an extensive range of costly drugs that are unavailable on the NHS. Cancer patients in particular can benefit from access to these drugs privately. However, the level of cover you have on your policy for these costly drugs will depend on your insurer.

  • Long hospital stays – If you know you’re going to be staying in hospital for a while, chances are you’ll want access to the comfort of your own private facilities. In a private hospital you’ll be given your own private room, TV and a good selection of food. It can make your time in hospital more bearable and provide a valuable boost to your spirits.

You may think there’s little point in using the NHS if you’ve got a private policy. It’s your choice to go private for all your treatment, but those struggling to meet the costs of their policy may prefer to only use it for very serious conditions and treatments. It all comes down to individual preference, just make sure you consider your options and make an informed decision. It’s easy to change your mind and go private later, but it can be difficult to go from private treatment to the NHS without experiencing delays.

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