Helping your patients understand their cover

We want your patients to understand how we can support them.
That’s why we explain their plans in language that’s familiar to them and do all we can to make sure they understand how their plans work.
Below is a brief summary of the most common issues which may affect your payments and help you navigate any charges due to you from our members.

All patients must preauthorise their treatment with us. We currently ask patients to do this by calling the Personal Advisers in our customer services team. They will find the relevant telephone number on their policy documentation. Once the treatment is approved, please request the authorisation number alongside your patient’s membership number. Please note that 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.

This is the amount of money a patient must contribute towards the cost of eligible treatment before we can make a contribution to fees.

Outpatient allowance 
Some policies have an allowance to cover outpatient costs, such as consultations, pathology and radiology.
The treatment proposed may draw on this allowance. We send your patients benefit statements advising them of any costs their membership doesn’t cover. They should settle these costs with you.
When there is an excess or some other type of shortfall we want to give your patients your bank details so they can send the money straight to your bank account. If you want to share your bank details with your patients, please complete the relevant section in your profile on the Private Practice Register.

Urgent treatment limitations
Some policies don’t cover certain treatments if, for example, the same treatment is available on the NHS within four to six weeks.
If your patient has this limitation on their membership and their treatment would be available on the NHS under a suitably qualified specialist (not necessarily you), then it’s important you transfer their care to the NHS straight away. We may contact you to confirm local NHS times when seeing patients with this type of plan.

60/40 Rule
Some Health-on-Line members may be asked to pay 40% of the total treatment costs when they choose to see you. We’ll make them aware of this limitation when they call to preauthorise their treatment and before seeing you.

Your patients can also consult short ‘Sense Checker’ videos on our YouTube channel to learn about how we approach pre-existing and chronic conditions, their moratorium, excess and outpatient limits, what the six-week rule is and why we may request more information.