What it does
- Provides facilities, nursing and support staff for planned treatment.
- Quotes package prices for self-pay patients and negotiated rates with insurers.
- Treats both privately funded and NHS-funded patients in many cases.
- Sets the criteria for what it can safely treat on site.
How it is paid
- By insurers at agreed rates, by self-pay patients directly, and by the NHS for NHS-funded work.
- Consultants normally bill separately, so one episode can produce several invoices.
- Package prices assume a standard course of events; complications change the bill.
What it is regulated to do
- Regulated for safety and quality by the health regulator for its nation, not by the FCA.
- Required to publish performance and fee information through PHIN under the CMA’s order.
- Subject to inspection reports that are published and free to read.
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
- Complaints about care go through the hospital’s process and then the health regulator or independent adjudicator.
- The Financial Ombudsman Service covers the insurance side, not the clinical side.
- Inspection ratings and PHIN data let you compare before you book.
| 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
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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Stuart Hendy
PMI Expert and Head of Publishing, PremierPMI
- 20 years in UK private medical insurance
- Underwriting and corporate placement specialist
Stuart brings over 20 years of experience advising on UK private medical insurance. He is a key member of the private medical insurance team and Head of the Publishing Team, gathering detailed client requirements, liaising with insurers on tailored quotes, and running training on insurer product changes and underwriting nuance.
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