How Does Payment for Private Healthcare Work?

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Private medical insurance (PMI) or private healthcare is known to pay for private medical treatment, test(s) and/or surgery if you’re injured or ill in the duration of the health insurance’s policy. Technically, the desired purpose of private healthcare is for acute conditions, which means conditions that are curable and short-term.

Sometimes, people pay for private healthcare even while they aren’t sick – this is called Preventative care. This can mean annual GP visits for check-up’s and screenings, which ultimately avoids or reduces the chances of developing a serious condition later on.

Usually, you’d be expected to pay a monthly or annually amount for your health insurance, i.e. the insurance premium. Your insurance policy then pays out if you need treatment/care that it covers while your health insurance premium is still valid/active.

How Payments Work

How much you pay for your health insurance each month or year can either cover some or all of the medical care you receive, whether it’s from a GP or a hospital. These costs cover not just doctor/specialist visits but also prescription drugs and doctors’ visits all the way to health improvement programs.

There are a number of categories for these costs, which are;

  • Deductible
  • Copay
  • Co-insurance
  • Out-of-pocket maximum


A lot of health insurance plans include a deductible; this is the amount you have to pay each year before your health insurance plans pays for covered services. If you plan has a £2000 deductible, for example, you will have to pay the first £2000 of the costs for the private healthcare services you receive.


A copay is a fee you need to pay to see a doctor or receive some other covered services, like a visit to the emergency room. An example would be; going to see a doctor would require a £30 copay, but to visit the emergency room would be £300. 


Co-insurance is a percentage you’ll have to pay for some services, for example, a trip to a specialist or a specific medical test. Depending on the insurance policy you have (as some covers may be different), if your co-insurance is 20% your health insurance company will have to pay 80% of the cost of covered services.

Out-of-pocket Maximum

An out-of-pocket maximum is the most you’d have to pay for your health care expenses. It’s usually within a year, for covered healthcare treatment you receive from the doctors/hospitals/healthcare facilities that are part of your plan.

Pay-As-You-Go Healthcare

Alternatively, there is the option of ‘pay-as-you-go’ private healthcare. In reality, this is just the traditional act of a direct payment to a professional doctor or specialist for a treatment – by debit card, post, cheque or online payment. Here is a step-by-step process:

Firstly, you will need to request a GP referral letter; some consultants will want a referral letter from your GP to ensure your medical needs match their specific expertise. Although in some cases it’s not a necessity, most consultants will require it.

Secondly, you will have your first consultation which involves a basic examination and an analysis of your medical history. After, you’ll require a follow-up appointment to discuss the results of your basic examination & possibly discuss price packages. 

Thirdly, a treatment plan and final price package will be decided, and a final treatment date will be set if possible.

Then, your consultant will send you a final bill for the cost of the initial consultation as well as the cost for any further testing or treatment. Normally you can pay this via debit card, bank transfer, via telephone, by post or online. After your payment has been accepted, then you will undergo your treatment.

Sometimes, depending on the help you seek, it is possible to pay for your pay-as-you-go treatment via a loan; in which monthly instalments can be paid over a time period that best suits you.

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