What it does
- Sees you in clinic, recommends and carries out treatment, and follows you up.
- Sets their own fees, which may or may not match what your insurer will pay.
- Usually works across NHS and private sites.
- Decides, clinically, whether a procedure is appropriate at all.
How it is paid
- By the insurer at the insurer’s fee schedule, or by you directly if you self-pay.
- A fee above the insurer’s schedule creates a shortfall that you pay.
- Fee information for many consultants is published through PHIN.
What it is regulated to do
- Registered with the General Medical Council and required to hold a licence to practise.
- Granted practising privileges by each private hospital they work at.
- Not regulated by the FCA — a clinician is not an insurance adviser.
Anyone arranging or advising on insurance in the UK must be authorised by the Financial Conduct Authority or be an appointed representative of a firm that is, and you can check any firm or individual free of charge on the Financial Services Register. [1] The conduct rules that apply to insurance sit in the FCA’s insurance sourcebook. [2]
What protects you
- The medical register shows registration, licence and any restrictions.
- Complaints about clinical care go to the hospital and, if needed, the GMC.
- The Financial Ombudsman Service cannot rule on clinical decisions.
| The problem | Where it goes |
|---|---|
| An insurance sale, a policy decision or a declined claim | The firm’s complaints process first, then the Financial Ombudsman Service |
| A firm that has failed owing you money | The Financial Services Compensation Scheme |
| Care or safety at a hospital or clinic | The provider’s complaints process, then the health regulator for your nation |
| A doctor’s conduct or fitness to practise | The General Medical Council |
| Something we have published | Our own corrections route on the complaints page |
The Financial Ombudsman Service resolves complaints about regulated firms free of charge, [3] and the Financial Services Compensation Scheme can pay compensation where an authorised firm cannot. [4] Care regulators publish inspection reports for private hospitals as well as NHS ones, [5] and the medical register shows whether a doctor holds a licence to practise. [8]
Questions worth asking
Free and impartial guidance on any of this is available from MoneyHelper. [9] Private hospital and consultant performance and fee information is published by PHIN under the Competition and Markets Authority’s order. [6] [7]
Sources and methodology
- [1] Financial Conduct Authority. “The Financial Services Register”. View source(opens in a new tab)Primary source
- [2] Financial Conduct Authority. “Insurance: Conduct of Business Sourcebook (ICOBS)”. View source(opens in a new tab)Primary source
- [3] Financial Ombudsman Service. “Financial Ombudsman Service”. View source(opens in a new tab)Primary source
- [4] Financial Services Compensation Scheme. “Financial Services Compensation Scheme”. View source(opens in a new tab)Primary source
- [5] Care Quality Commission. “Find and compare care services”. View source(opens in a new tab)Primary source
- [6] Private Healthcare Information Network. “Private hospital and consultant performance and fee information”. View source(opens in a new tab)Primary source
- [7] Competition and Markets Authority. “Private healthcare market investigation”. View source(opens in a new tab)Primary source
- [8] General Medical Council. “The medical register”. View source(opens in a new tab)Primary source
- [9] MoneyHelper (Money and Pensions Service). “MoneyHelper — free and impartial money guidance”. View source(opens in a new tab)Primary source
We cite primary sources wherever possible. Read about our sourcing methodology.
Guides that explain this in full
Muhammad Junaid
Digital Marketing Executive, PremierPMI
- Digital marketing and search
- Financial promotions compliance review
Junaid leads digital marketing — search, content distribution and measurement — working with the editorial and advisory teams so that every campaign points to real, compliant guidance. He reviews anything published under the brand against the same fair, clear and not-misleading standard as the rest of the site.
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Andrew Buscu
PMI Specialist & Copywriter, PremierPMI
- Whole-of-market private medical insurance adviser
- Claims and renewal specialist
Andrew is a member of the private medical insurance advisory team. He gathers detailed client requirements and liaises with insurers to arrange tailored quotes across the whole UK market, guiding clients from first quote through to claims and renewal. In one case he reduced a client renewal premium from £36,000 to £11,520 without reducing cover.
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