How Private Medical Insurance Worked For Me

by Serena Cowdy on 22 August 2008  |  8 comments
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A personal experience recently made Serena Cowdy take a closer look at her private medical insurance. This is her verdict.

I used to think that private medical insurance (PMI) was an obscure employment perk that, as a young and healthy individual, I would probably never need.

Recently, however, I had cause to claim on the PMI I was covered by as a Fool employee. And I ended up being extremely glad that ‘obscure’ benefit was part of the package.

Here, I’m going to outline how PMI worked for me. I’m also going to examine the pros and cons so you can decide whether it’s right for you. 

How PMI worked for me

I’ve suffered headaches, on and off, since I was a teenager. However, earlier this year they got markedly worse. They would last for three or four days on end, always seeming to stem from behind my left eye. They would regularly be accompanied by flashing or tunnel vision, dizziness and feelings of nausea.

I visited my local GP. He said he had no idea what was causing them, but frankly, didn’t seem overly concerned.

When I pushed him, he said he could refer me to an NHS neurologist. However, he emphasised that this could take several months, and at the end of it all, they were unlikely to give me an MRI scan anyway because, in his words, they cost the NHS an arm and a leg.

That was the moment I decided to claim on the BUPA PMI I had as an employee of The Fool.

The process was not without hitches. I had to get various forms signed by my GP presumably to prove that he deemed referral to a specialist necessary.

And there was also a sticky moment when someone from BUPA told me that I probably wouldn’t be covered anyway because my headaches were a pre-existing condition. My argument was that they’d suddenly got a lot more frequent and severe.

In the end, BUPA agreed to cover the cost of the specialist, and for the MRI if he deemed one necessary but not the cost of any treatment that might subsequently be needed.

I could live with this, I decided, because if the MRI did uncover any nasties I could run screaming to the NHS with a pretty strong case to be treated right away.

Once the paperwork was sorted, I was zoomed into a private appointment with a Harley Street neurologist within a week.

He, too, admitted he couldn’t pinpoint the cause of the headaches, and said an MRI would be advisable ‘if only to put my mind at rest’. In another couple of days, I was strapped into a scanner having my brain zapped.

And the result? Thankfully, everything was normal. There were no worrying lumps, and no (apparent) brain abnormalities. I was even given a fascinating CD - images of my head’s internal workings from every conceivable angle.

So the dreaded ‘tumour’ possibility had been eliminated. Tension was cited as the most likely cause of my headaches, but perhaps I’ll never know for sure.

The pros and cons of PMI

In light of my recent experience, the following points spring to mind:

Exclusions and loopholes: When deciding whether PMI is for you, you do have to scrutinise all the exclusions that apply.

There are usually a host of things that aren’t covered. These can include pre-existing conditions (as in my case), incurable or lifelong conditions, mental health problems, treatment for HIV/AIDS, and treatment overseas - to name but a few.

My Foolish colleague Neil Faulkner examines this problem further in Health Policies: The Costs, Cover And Cancer Exclusions.

The frills: Private medical care does undoubtedly come with some luxurious extras. I got to sit in a lovely plush consultant’s surgery, surrounded by flowers and antiques.

Personally, I didn’t really care - and that free CD was illuminating, but certainly not essential. However, if I had been somewhere longer-term -- as an overnight patient for example -- perhaps I would have appreciated these frills a little more.

The bits that count: For me, the three main plus points of PMI were the speed with which I got a specialist appointment, the willingness to perform expensive diagnostic procedures, and the opportunity to get a second opinion.

When no one knew what was wrong with me, and I had got myself into a ‘worst-case scenario’ panic, BUPA was willing to put my mind at rest - for a price.

The verdict

Well, PMI still won’t be the highest priority on my insurance list. I do believe the NHS is fundamentally a sound and admirable service.

Most private practitioners are, in fact, NHS medics boosting their income. And I don’t believe the level of treatment I received was superior to the NHS equivalent.

However, I was scared and I wanted a quick and conclusive diagnostic result, if only to eliminate the one scenario (a tumour) that I feared the most. For me, that’s where PMI came up trumps.

So, would I take out PMI if it wasn’t part of a company package? To be honest, I’m not sure. I operate on a pretty tight budget, and at the moment, I think I have higher financial priorities.

However, I will definitely be scrutinising employment contracts more carefully in the future.

Some employers may pay for PMI for you or even for your whole family. So understanding your company benefits could make a huge difference if a loved one falls ill.

And finally, if your employer doesn't have a scheme, see if your partner's company will allow you to join theirs - many now do.

For me, peace of mind is definitely worth that much.