Physiotherapy and your health insurance

With the well-publicised difficulties the NHS is currently having, a lot of talk has turned to the benefits (or otherwise) of private health insurance.  Now, I make no claims about being a great expert on the subject, but around half of our patients at Victory have their treatment fully or partly funded by their health insurance, and the rest self-fund, so I have some experience and some opinions which I’m happy to share. Not all health insurance companies are created equal, by a long chalk - and each company sells a variety of different policies, so this is very much not a comprehensive guide.

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At Victory, we are currently able to work with:

  • Cigna
  • WPA
  • Bupa International (not standard Bupa)
  • SimplyHealth
  • Allianz
  • Aviva
  • Anyone else whose criteria is HCPC registration

Some health insurance companies will recognise Victory as a provider of services; but others will not recognise clinics and only work with specific individual therapists who are registered with them as providers. Clinics that insist on working with specific therapists include Cigna and Aviva (Lauren and I both have individual provider numbers) and also Bupa and AXA.

We do not work with Bupa (Bupa International is a separate company), Vitality Health or AXA-PPP. This is because any practice that signs up to work with Bupa or AXA has to agree to a very specific code of practice. This includes:

  • All three companies only cover 30-minute sessions. In most cases, I believe a 30 minute session is frustratingly inadequate, so we don’t offer them.  An assessment with us takes 90 minutes, and treatment is at least an hour - we can't offer the high level treatment that our patients deserve in just 30 minutes. 
  • Bupa and AXA only pay up to around £40 for a 30-minute session, and Vitality Health will pay up to £35. We want to be able to offer you treatment from staff with excellent credentials and training, in facilities that are of a high standard, in a convenient location. Our clinical team would need to be completely booked up, around the clock, seven days a week - and even then, we wouldn't be able to afford to send our team on courses or buy extra equipment for the clinic. 
  • Bupa and AXA insist that clinics who have signed up with them promise to apply the above rules (30-minute sessions costing no more than £40) to all clients whether they are covered by AXA/Bupa or not. So nobody else would be allowed to work with us in the way we feel is best, or benefit from longer treatment sessions.
  • We would not be allowed to ask Bupa/AXA patients to pay the difference between the amount the insurance company would pay, and the cost of a Victory session.  There are several other insurance companies that do allow this co-payment system, but Bupa and AXA do not.
  • We would have to agree never to let our session average go above 5.5 sessions per client. Given that we specialise in treating complex, long term and serious injuries, this is totally unrealistic.  We want to treat you until you are better, not until a computer algorithm says you are becoming too expensive.
  • We would have to set aside specific sessions for Bupa/AXA patients, whether they used them or not.  This would not exactly be helpful when it comes to keeping our waiting list down!
  • We would have to put together a specific set of statistics for Bupa/AXA patients whenever they asked us for them.  We do keep detailed records, but we don't necessarily always think the specific questions that Bupa/AXA ask are relevant to every patient, and we'd rather focus on the things that are relevant, as opposed to carrying out box-ticking exercises.  

This is too restrictive and we have said no. If you have health insurance with BUPA, Vitality or AXA then we are very happy to help you, but you will have to fund your own treatment (as around half of our current patients prefer to do).

Within the companies that we are able to work with, insurance policies vary widely. 

Some employers subsidise health insurance for their employees as a tax break, known as corporate health insurance. If your company offers this and you'd like to take advantage of the company scheme, then you can only use the health insurer chosen by your company (bummer if it’s Bupa!)

Whether it's private or corporate, the monthly fee varies tremendously – anywhere from around £50 to several hundred pounds per month. There are various factors involved in this, such as:

  • Are you a high risk individual (i.e. lots of pre-existing conditions, smoker, heavy drinker, doing dangerous sports)?
  • What do you want the insurance to cover (basic or all the bells and whistles)?
  • Are you paying yourself or is it corporate?
  • Is there an excess on your policy, and if so, how much do you have to pay?

Coverage varies tremendously. Some insurance policies include physio, some don’t. Some include massage – most don’t. Some limit their policyholders to a financial limit, others to a set price per session, others to a specific number of sessions – per injury or per year.

Access varies. Some policies allow you to self-refer to physio. Others require a GP referral or even a consultant referral. Similarly, if we want to refer you to a consultant, we may need to do this through the GP – depending on the policy.

Invoicing varies. Some insurance companies allow us to invoice them directly. Others require you to pay the bill – we then provide you with a receipt and you can claim some or all of it back.

Excess varies. Some policies have none, some have a very high excess. This means that you as the policyholder may have to pay the first £100 of the physiotherapy bill, or the annual bill; or the first 20%.

Health insurance, then, is a complicated beast. We will do our best to help you, and will ask you the questions you need to know about; but it is your responsibility to find out the answers from your insurer and to understand what your policy covers.  If you are planning to fund your treatment through insurance, we may need your policy number, your authorisation number, whether you have an excess to pay or not, exactly what is covered (whether your limit is financial or by number of sessions), and whether it is you or us that must contact them if we need them to authorise further treatment (and how - do they need a report on a specific form, or will they accept a telephone call?).  This is vital, because if your insurer refuses to pay, then you will be liable for the bills - and we don't want to charge you when you could have got the insurance company to pay!

Of course, not everyone has (or wants) health insurance.  It's a gamble; and the vast majority of people who pay into their insurance schemes never use it. I have plenty of clients who prefer not to invest in insurance, but who save the money they would have spent on insurance in a separate account, and pay for their treatment using this.  But if you do want it, it's worth considering the above points before taking the cheapest option.

Nell MeadComment