Clinical Decision-Making

We have clinicians working throughout our business, including GPs, surgeons and other specialists, physiotherapists and other practitioners, nurses and other healthcare professionals. 

Our Chief Medical Officers direct our clinical policy and strategy decisions.

Our customer service clinical teams advise on appropriate treatment for members when they call seeking help. 

Our dedicated nurse telephone lines support patients with cardiac and cancer claims, in addition to a 24-hour health information service. (links)

Our provider clinical team advises on fees, procedure and payment queries, audit and investigations. (link)

We make funding decisions about patients’ proposed treatment by referencing NICE guidance and up-to-date research.

If we can’t fund treatment, this may not be because it’s not clinically appropriate, but because it’s not covered by the member’s policy.