Using your private health insurance

Simply visit your GP and ask them to refer you to Spire Edinburgh Hospitals. The majority of GPs in Scotland will refer you to the hospital via a secure referral system called SCi Gateway or they may write a letter of referral.  

Once we have received your referral letter we will aim to call you within 24 hours to arrange an appointment at a convenient time.

Scheme/policy details are required at the time of booking an out-patient appointment so that we can obtain pre-authorisation.

Your insurance company may require your GP to complete some sections of a claim form. Your GP might make a nominal charge for this service.

If you and your consultant have agreed that you require treatment, we will arrange your admission for a time that suits you.

If you need any help or advice, we’re here to help. Just give our out-patient booking team a call on 0131 316 2530.

It’s important you understand the coverage your insurer provides, as you’re responsible for the costs of your treatment.

Before attending your first appointment, you should contact your insurance company to check that your condition is covered and if you require treatment will your insurance company cover all stages of treatment.

The best way to make sure your insurance company will cover your costs is to contact them prior to each stage of treatment - such as before your first outpatient appointment, diagnostics (for example CT or ultrasound scan) surgery and follow-up care.

You should also check your policy for any limits on the amount you can claim on certain types of treatment. Most policies will have an annual excess and limits - for example on the amount payable for out-patient treatment. Also check: 

• if there are any monetary limits for out-patient treatment
• if out-patient coverage is restricted to claims that result in a hospital admission

Claims processes differ from insurer to insurer. Your insurer will guide you through their specific process. If your employer provides your insurance, you should follow the claims process specific to your scheme. 

Occasionally your insurer may require your GP or consultant to fill out a claim form. If your insurer requires a claim form you should follow the below steps.

• Bring it with you when you attend your first outpatient appointment.
• At your consultation please let your consultant know that you have a claim form and that you would like them to complete the relevant sections. 
• If your claim form requires a stamp, please ask a member of our reception team to do this for you. 
• If you are being admitted for in-patient or day-case treatment, please notify your consultant that you require the consultant to complete the medical section on your claim form.  
• Make sure you have completed and signed the "patient/member" section on the claim form.

We require the following information, or if you are unable to provide this, please bring it on the day of your initial out-patient appointment. 

• your insurance company name and scheme details
• your membership or policy number
• any confirmation of eligibility such as a pre-authorisation or claim reference number.
• your completed Spire Healthcare registration form
• credit/debit card details - this will be held on file to cover any policy excess or claims that your insurance company does not settle. (Please note that we will send you a detailed invoice and seven days later your credit/debit card will be charged.)

If you cannot provide full insurance details or if your insurance does not cover the full cost of your out-patient treatment, we must hold your credit/debit card details on file and we will send you a details invoice following your appointment. 

For most patients, treatment costs are based on agreements with your insurer and payment will be made direct by your insurance company.

We charge for our hospital services such as nursing, use of our facilities, medical consumables etc. Our consultants - surgeons, anaesthetists and physicians - charge independently for their time and expertise. Spire Edinburgh Hospitals has introduced a combined billing system for the hospital, consultants and other consultant-initiated diagnostic charges. If your consultant is using this combined billing system your insurer will receive an invoice from Spire Edinburgh Hospitals only. If your consultant is not using this combined billing system your insurer will receive an invoice separately from the consultant for consultant fees.

To make things easier for you, we have direct settlement arrangements with the major UK insurance companies. Your insurer will normally settle your bills from your consultants and us directly. In order to do this we’ll need to know:

• your insurer
• your registration number
• your scheme details if you are insured under a company scheme
• your pre-authorisation number for your treatment.

We’ll ask you for credit/debit card details when you book your initial appointment or alternatively we can swipe your card when your arrive for your appointment. This is to cover any insurance excess or shortfall your insurer is not liable to pay such as for sundry items. Your details will be kept securely for up to six months and we will notify you in advance if it’s necessary to use them.

In addition to any insurance excess or co-pay, sundry items may include:

• specialist equipment to aid recovery eg a wrist brace, crutches
• drugs to take home - each insurance company will cover different amounts of days worth of take home drugs
• personal expenses such as international telephone calls, meals for visitors, newspapers. 

Excesses and balances not covered by private health insurance

If you do not have sufficient cover or if there is an excess on your policy, your insurer will advise you of the outstanding payment due to the hospital. They will also notify us of your excess/out of cover charges and we will send an invoice to you advising of the balance to be processed against your debit or credit card.

Consultants may invoice to you directly at your home address and it may be necessary for you to forward bills to your insurer.

Below is a list of contact details for popular insurance companies:

APRIL UK
New customers: 0800 028 0849
Existing customers: 0800 028 0849
Website: www.april-uk.com 

Aviva 
New customers: 0800 056 7654 
Existing customers: 0800 158 3333
Website: www.aviva.co.uk/health

AXA PPP Healthcare
New customers: 0800 111 4004
Existing customers: 0800 45 40 80
Website: www.axappphealthcare.co.uk

BUPA
New customers: 0800 600 500
Existing customers: 0345 609 0111
Website: www.bupa.co.uk

CIGNA
New customers: 01475 492 222
Existing customers: 0345 722 4462
Website: www.cigna.co.uk

CS Healthcare
New customers: 0800 917 4325
Existing customers: 020 8410 0400
Website: www.cshealthcare.co.uk

Exeter Family Friendly
New customers: 0300 123 3250
Existing customers: 0300 123 3200
Website: www.exeterfamily.co.uk

General & Medical
New customers: 0800 970 9442
Existing customers:
Website: www.generalandmedical.com

HEALIX
New customers: 0800 028 0849
Existing customers: 0203 819 7159
Website: www.healix.com

Police Mutual
Healthcare customers: 0345 606 9901
Website: www.policemutual.co.uk

Saga
New customers: 0800 015 0226
Existing customers: 0845 300 0867
Website: www.saga.co.uk/health-insurance

Simplyhealth*
New and existing customers: 0800 294 6796
Website: www.simplyhealth.co.uk 

Vitality Health**
New customers: 0800 779 955
Existing customers: 0345 602 3523
Website: www.vitalityhealth.co.uk

WPA 
New customers: 0800 298 9588 
Existing customers: 01823 625 000 
Website: www.wpa.org.uk

*Part of AXA **Previously PruHealth

If your insurance company is not listed above, please refer to your policy documents for the appropriate phone number.

Our expert care is still within your reach, even if you don’t have private health insurance.

Paying for your own treatment is a quick and easy way to get immediate access to the healthcare you need. To find out the cost of your treatment call our self pay team on 0131 316 2507 or complete an online enquiry using the enquire button on this page. 

Find out more about finance options available

Private health insurance is designed to cover the costs of private treatment for unexpected (acute) medical conditions. By paying a regular amount (premium) to an insurance company, you can avoid having to pay the potentially expensive, unexpected costs of treatment and gain access to fast medical treatment from your choice of the UK’s private healthcare providers.

Many insurers describe the types of conditions that they will pay for as those that are short-term and respond to treatment. They will not generally cover the costs of treating on-going chronic conditions that you were aware of before you were insured.

Private medical insurers will usually not cover you for any conditions that were diagnosed, treated, or for which you sought medical advice before your insurance started.

They will also usually not cover the costs of treating chronic, incurable conditions. In addition there will be a list of exclusions on your policy – these commonly include GP services, prescriptions, and A&E admissions.

Depending on the policy you have, there may be limits on the total amount you can claim on certain types of treatments.

This is common for such treatments as physiotherapy, chiropractic, osteopathy etc as well as an overall out-patient claim limit. Check your policy documents or contact your insurer to find out if you have limits to bear in mind.

Some policies do reward members who do not claim on their private medical insurance policies.

Even if you make no claims, however, the cost of your annual premium is likely to rise over time reflecting your age and the rising costs of providing medical care – new drugs and technologies in hospitals are often expensive.

When you apply for health insurance you will need to make a declaration on a form regarding any pre-existing and past medical conditions. If you have any pre-existing conditions they will not normally be covered by your new policy for a set period of time – perhaps two or five years.

Yes, but you will need to disclose your disability in your medical history declaration. Your insurer may not cover treatments you require as a result of your disability since they involve a pre-existing condition.

Yes it is possible to change insurer. Speak to an insurance broker or a new insurer and they will be able to advise you about the way switching will affect the terms and level of your cover.

It is usually necessary to go to your GP and get a referral for private treatment in order to make a claim to your insurer. Occasionally a claims form may need to be signed by your GP or the specialist you are referred to. Once you have a referral from your GP simply contact your insurer to confirm that they will cover you – this is called claims authorisation. You can also clarify with them how they will pay for the claim and what to do next.

Under most private medical insurance policies you will need to pay an excess charge on each claim or you may have to pay an excess charge for each rolling year period, while the insurer will cover the costs of eligible treatment under that claim. Some policies also require you to meet a proportion of treatment costs up to a specified limit. You will need to consult your policy documentation to confirm arrangements for your scheme.

A co-payment is when you share some of the costs of your treatment with your insurer. The amount you need to co-pay will depend upon your policy, the location and type of treatment you are having. When you contact your insurer for authorisation of a claim you can check if any co-payment will be required. A co-payment may also be required if you select premium lenses when you are having cataract surgery.  A premium lens will fully correct your distance and reading vision so that you no longer require spectacles or contact lenses.

Yes, the Financial Services Authority (FSA) regulates the sale of all types of insurance including medical insurance. If an insurer or insurance broker is a member of the General Insurance Standards Council (GISC) they will also be bound by the regulations of that body.

The Association of British Insurers (ABI) publishes a free guide to purchasing health insurance, designed to help you understand more about how private medical insurance works, so that you can make an informed choice before buying a policy. Visit www.abi.org.uk

Given that private medical insurance can be a difficult product to understand, we suggest that it would be worth discussing with a PMI broker who will be able to review your policy and could give you options. If you need to find a broker, then you should look for one who is authorised by the FSA. The Association of Medical Insurance Intermediaries website can help people looking for a suitable broker. Visit www.amii.org.uk