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PRIVATE HEALTH INSURANCE :IS IT WORTH IT???

 Poster: A snowHead
Poster: A snowHead
Looking at this thread makes me so glad I live in France - yes the tax and ni (equivalent) are high the system is wierd and quirky - but for €350 a year on my mutual almost everything is covered and the stuff that isn't covered is not more than a few pints of beer.

If specialist treatment is available here you might have to go a roundabout way to get it - but it should be on the system

Its not without many faults and too many people have too much faith in it's infalability to always work - I know of 2 friends who's ACL rebuilds failed because they just went to the first surgeon available or the nearest - rather than looking into things
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Idris wrote:


Its not without many faults and too many people have too much faith in it's infalability to always work - I know of 2 friends who's ACL rebuilds failed because they just went to the first surgeon available or the nearest - rather than looking into things


The ACL will re rupture in at least 5%. Even the best respected names in the world will see that. Some think it is a bit higher. There are some surgeons who feel that the surgery is all that is required. They fail to acknowledge the importance if rehab.

Some believe surgery is simply the starting point for a comprehensive rehab programme where the target result is to return to full sports.

There is quite a difference in outcome in my opinion.

Jonathan Bell
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
Jonathan Bell wrote:
Idris wrote:


Its not without many faults and too many people have too much faith in it's infalability to always work - I know of 2 friends who's ACL rebuilds failed because they just went to the first surgeon available or the nearest - rather than looking into things


The ACL will re rupture in at least 5%. Even the best respected names in the world will see that. Some think it is a bit higher. There are some surgeons who feel that the surgery is all that is required. They fail to acknowledge the importance if rehab.

Some believe surgery is simply the starting point for a comprehensive rehab programme where the target result is to return to full sports.

There is quite a difference in outcome in my opinion.

Jonathan Bell


Having gone from injury through intensive rehab to skiing at a reasonable level before surgery I agree very much that surgery is only the start of the process.
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I think the question is a bit daft

1. Depends on how much spare money you have and what else you would be spending it on.
2. Depends on whether you value something more when you pay for it at the time.
3. Depends where you live in the world / UK
4. Depends on the nature of your problems.
5. Depends whether you think an "NHS physio" is rubbish and "private physio" is great- even though they are likely to be the same people.
6. Depends whether you think it is a good idea to be treated in a private hospital in the UK, which it might be if there is nothing much wrong with you (hernias, bone and joint surgery etc) but a decidedly bad idea if all of a sudden there is (need for revision, infections, complications, bleeding, near death). In which case you will be transferred to the NHS pronto. (Usually).
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
ed123, on your point 5...yes they are potentially the same people but they just don't have enough time in their nhs work. I had 3 or 4 nhs appointments and was discharged as soon as she could get me out of the door. She was pretty embarrassed.
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I was told I was put down for Urgent NHS physio after I had cracked my kneecap and had it in a brace for 7 weeks - that was then arranged by letter so not exactly fast and I couldn't speed it up on the phone, - so I went to see my private physio for 3 or 4 sessions and was well on the way to getting the leg moving again by the time the NHS apt came through and that date was about 4 weeks after being told I needed it. The nhs appointments were very brief. I was just glad that I could afford the private sessions as we no longer have BUPA or the like.
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Then you can post your own questions or snow reports...
ed123, I have had a very good NHS Physio and an atrocious NHS Physio, I have also had a mediocre NHS one. I have only ever had good private physios. I suspect that mediocre or atrocious private physios won't stay in business very long.
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
Quote:

With self-pay and complications, again, costs are payable, and can escalate

but you can often get a "fixed price" for standard procedures. My OH had a triple bypass in a BUPA hospital on fixed price. He had complications related to diabetes and lung difficulties which extended his stay by some days, but all the additional costs were covered in the fixed price, except a consultation fee with a diabetic specialist, which wasn't a big cost.

Insurance of any kind generally exists to make money. If everybody got more out than they paid in, it wouldn't work. So it's a gamble. A few people who are very unlucky with their health will get masses more out of the system than they pay in. But that is balanced by the many who pay for years and make no claims. If you have savings and can afford the lump sum (in the case of my OH's operation it went on the mortgage) then on average you're better off self-insuring.

Even a fairly hefty op only costs around the same as a family car - and many policies won't cover you for chronic conditions anyway.
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I currently pay approx 100 euro's a month for my health insurance in the Netherlands. It is compulsory by the way. That still doesn't cover things like prescriptions and visits to the hospital if x-ray's are needed ect. I do sometimes wonder what the hell it does cover?
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i think it worth
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snowHeads are a friendly bunch.
Zero_G wrote:
I've had two surgeries in three years. Both by surgeons I have selected, both top in their field.

I was wondering Zero_G how you knew they were "top in their field"?
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
Following on:
The downside of Private Practice - there is far less scrutiny in Private Practice than in the NHS.
And also highlights the problem of general public trying to identify the optimum doctor to go to - Ian Paterson was thought by many to be one of "the top in his field".

There needs to be the equivalent of "Which" for Health.
Not CQC with its spreadsheets and silly targets
but a proper consumer forum to provide useful information.
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So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
Jonathan Bell wrote:
brnttptr,

That data will be well protected , any actuaries out there!

I think insuring the kids before teens probably a waste of money but it does seem a bit neglectful to insure myself but not them!

The risk is reflected in the premiums.
The need, particularly for expensive care( cancer, joint replacement cardiac etc ) kicks in after you have paid up for decades. So they hike the premiums to punitive levels to get rid of you. Sadly the group who seem to be most likely to give up their insurance are the over 60s . I've heard of premiums in excess if £5000 PA in this age group.


From the age of 50+ men and women tend to have very high increases in incidence of cancer and cardiovascular related illness. These two groups of conditions, are the reasons premiums go up when you are in your 50's. Some older long term policies allow you to have a guaranteed premium over a fixed number of years (say 20 - 25), which does not vary as you age. These policies would be higher in price at younger ages, and for this reason most people when they take out such policies only consider what they pay now rather than what they will have to pay when they get over age 50.

The major issue in private medical insurance is the inflation of expenses. In other words the costs of getting conditions treated escalate per annum way way in excess of inflation. This is probably due to medical advances, rather than private medical doctor fees.

Getting guaranteed premium medical expenses insurance is probably not possible over a fixed term now. It is just not sold due to the risk of out of control medical expense inflation.

Personally, I would look at critical illness policies which pay a lump sum on diagnosis of serious illnesses which are defined. These are lower cost, and would help you fund any private medical expenses for these illnesses. I am not aware of psychiatry which is available on private medical insurance. Psychiatry tends to be something which is ill defined, and consequently difficult to definatively diagnose. Therefore, opening up the problems of whether a claim is valid or not. (fraud in insurance would be rife)

Fixed term critical illness policies on an individual basis (or joint basis) are often sold with life assurance. You may already have some cover!

Having the money to choose what treatment you decide on (for example a month skiing in Switzerland) then a visit to dignitas, is much more appealing than having to claim back money spent on medical expenses which have been decided on the advice of a privately operated clinician.

The TSO tends to publish data which cover the UK population on medical illnesses. It does not target this specifically at the insured population (which tends to self select in that they are usually on average healthier than the general population). There are other sources of data, but these are tightly controlled due to commercial sensitivity reasons. Obviously the NHS publish data too, as do the ONS....

The ABI have published this recently.

https://www.abi.org.uk/globalassets/sitecore/files/documents/publications/public/2017/health/health-insurance-guide.pdf

I am not sure who their audience is, I suspect by the tone of the document they think their audience is people who do not buy health insurance. The Cash plans explained within the document, which pay out for physio work, might be cheaper and specifically targeted to your needs. A critical illness policy is a form of a "cash plan".
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 You know it makes sense.
You know it makes sense.
interesting stuff, Bigtipper.

A common reason people produce for going Private is being able to get their treatment quickly.
But surely the better the surgeon/physician the more the demand for their services.
They would therefore have a significant Private Practice Waiting List.
So maybe you should be wary of anyone who is immediately available.
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:


This thread prompted me to look for some data to back up some of my assertions. Here is the cancer incidence rates for England in 2015 on a first release basis (in other words it is the latest data but there may be some minor changes due to delays in data recording and errors).

It highlights the fact that once you get to 50 your chances of getting cancer increase dramatically. Hence, one reason why private medical insurance is so expensive in this age group.

The incidence rates for cardiovascular related treatments would show a similar curve. (I have not found data to back this up yet, but I know this from previous studies in which I had older data which did back it up)

This is the best data I have found to date, from the British Heart Foundation website:



It shows the prevelance on the NHS register, by age grouping of people with cardiovascular diseases. It is not the same as an incidence rate of first admission for cardiovascular diseases, however it does show that the incidence rate would rise rapidly above age 50 for both men and women.

This graph comes from an article in 2008 in the British Medical Journal:(BMJ 2008;337:a2467)



The overall conclusion is the same, even though the precise incidence rates are not the same.

@Jonpim,

In my understanding, often private treatment is done by NHS staff. In other words they do both NHS and private (not one or the other). Certainly, there might be conflicts of interest, as dentists who do both private work and NHS work can testify to. However, I doubt that such conflicts of interest would influence the quality of work done by the same doctor (unless they have more time and flexibility to do the work)!

The two most avoidable causes of death in England according to ONS statistics, are neoplasms and cardiovascular diseases. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/avoidablemortalityinenglandandwales/2015-05-20

Injuries come a long way third as most avoidable mortality in England.

I would guess you avoid neoplasms and cardiovascular diseases by lifestyle and diet related activities.

If you follow this route, you would probably choose to self insure. (it would be cost effective on average, although some people may end up being the unlucky ones)

Note: some cancers are more terminal than others (eg. lung, liver, pancreas, oesophogus, stomach...), however most of the not non-melanoma cancers have a similar age increase in incidence rates. I suspect the non-melanomas are removed from the data as they are largely easily treatable and may be less age related in terms of incidence.


Last edited by Otherwise you'll just go on seeing the one name: on Mon 1-05-17 9:51; edited 2 times in total
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 Poster: A snowHead
Poster: A snowHead
Bigtipper, i probably explained poorly. I was not referring to possible conflicts of interest.
Rather, if you are good you would be in demand, and therefore either restrict access by cherry picking or make people wait.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Jonpim wrote:
Bigtipper, i probably explained poorly. I was not referring to possible conflicts of interest.
Rather, if you are good you would be in demand, and therefore either restrict access by cherry picking or make people wait.
In theory you should be right, but anecdotally it doesn't seem to work that way. Maybe because working privately is more financially attractive than working for the NHS there is more elasticity of supply for private work. I.e. surgeons are more inclined to work weekends, holidays, nights etc. Maybe they can reduce their NHS hours if they wish. I don't know. I can't say I've heard of anyone being unable to get the surgeon they wish due to excess demand but I suppose it must happen. It may also be that the supply of good surgeons who do some private work ( and other specialists) exceeds the demand from the private sector.
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
Jonpim wrote:
Bigtipper, i probably explained poorly. I was not referring to possible conflicts of interest.
Rather, if you are good you would be in demand, and therefore either restrict access by cherry picking or make people wait.


I think the excess demand or excess supply is location specific, rather than related to reputation. Specialists tend to not be located in out of the way hospitals and locations, and tend to be located in capital cities and large cities where they are not on their own. There is back up and support, and there are scapegoats which can be loaded with all the cases which will be a problem. (you cannot do that if you are in a location where you have to deal with all cases)

However, maybe this is changing so that people can overload surgeons who have a good score (due to doing a high level of low risk cases), and avoid surgeons who are very expert and tend to deal with difficult and high risk cases (causing them to have a low score). I do not know how the scoring system works, but however you do it, you will be misled if you are not a professional.

Is there such a thing as a scoring system? It would be very misleading if there was....

How do you define "reputation" to a patient who has never before had any dealing with a particular doctor/surgeon? In my experience, reputation of a person is only defined to me when I have had dealings with that person. That is how a reputation is made. It is rarely made by statistics, other peoples comments, or referals. These are often misleading, if you do not understand the system.

This means you have to trust, and paying for private medical insurance would not improve my ability to trust. It would just cost me money to bypass a queueing system.
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@brnttptr, I used to be with WPA, but switched to http://www.health-on-line.co.uk/, this year and took the 6 week option, I agree with one of the posts above that that loyalty doesn't count for anything with the insurance companies. WHen I switch from a company scheme to a self employed WPA where good a selling me their scheme however when it came to renewal they weren't interested in discussing the premiu, a friend recommended them and I also looked at Saga both health online and Saga are underwritten by AXA. I think health insurance is absolutely worth it.
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
Is PMI 'worth it?' Well, by definition insurance isn't worth it. Financially, there's no point in insuring something if you can take a long-term view and can withstand the cash flow shocks in the short term. Having said that, most people can't self-fund for major treatment and the long term view is limited to your lifetime. I'm not a great believer in many types of insurance but I do happily pay for PMI. Getting treatment when I choose, I.e. Quickly and at a time that suits my work schedule, is worth a lot of money to me. In addition I'd pay good money not to have to share a room with a lot of (other) snoring, farting, smelly people. PMI does bring peace of mind and I am also happy to pay for the choice it brings. However wonderful the NHS might be you do at least have an option when it's not wonderful.
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https://www.abi.org.uk/globalassets/sitecore/files/documents/publications/public/migrated/health/abi-consumer-guide-on-buying-private-medical-insurance.pdf

This guide from the ABI gives quite an in depth discussion of what PMI is, what is usually covers, and what it does not.

Some selective quotes:

The following conditions or treatments are normally not included in your cover.

• Going to a general practitioner (GP)
• Going to Accident and Emergency
• Drug abuse
• HIV/AIDS
• Normal pregnancy
• Gender reassignment (sex change)
• Mobility aids, such as wheelchairs
• Organ transplant
• Injuries you get from dangerous hobbies (often called hazardous pursuits)
• Conditions you had before taking out the insurance (commonly known as pre-existing conditions – see section 5)

Why buy private medical insurance?

People buy this type of insurance to have:

Timely access to healthcare

•Prompt referral to a consultant
• Quick admission to hospital
• Treatment at a convenient time

Choice of healthcare
• Direct care by a consultant
• Advanced treatment options

High-quality private clinic and hospital accommodation
• Privacy of an en-suite room
• Home amenities such as TV
• Comfort and cleanliness

In addition, PMI can pay you a cash benefit when you choose to use the NHS instead of having private treatment.

I can see the attraction if you see yourself as a Key person in a company. I have had BUPA PMI in a group scheme with an employer, but only really noticed the difference when nurses came into the office to give me a flu jab. I can see the Group PMI business taking off soon.

The problem is that when you are most likely to need the cover and make a claim, the premium will be the most expensive. With the doubt over what will be covered and what will not be covered, it does not seem worth hassle when you can just wait a while and get the treatment a few years later!

The ABI say they also have booklets for Health Cash plans if you wish to compare the benefits, and differences. Presumably you can pay for a private room in the NHS, and you could bribe a few administrators to advance quicker on the waiting list if you had some cash! NehNeh

https://www.abi.org.uk/news/industry-data-updates/2014/03/private-medical-insurance-2013-statistics-update/

latest statistics on PMI market in UK
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
Quote:

• Injuries you get from dangerous hobbies (often called hazardous pursuits)

Um! is skiing a dangerous hobby?
Quote:

but only really noticed the difference when nurses came into the office to give me a flu jab. I can see the Group PMI business taking off soon.

My employer ran a private flu jab clinic without any PMI, it cost us £5 a shot.


Quote:

High-quality private clinic and hospital accommodation
• Privacy of an en-suite room
• Home amenities such as TV
• Comfort and cleanliness


Not really sure about this one. In a public ward (I have been in a few) it is nice to have things going on around you during the day, you don't feel so alone. In a private room I have been generally more afraid and lonely. As for comfort and cleanliness I have never had anything to complain about in a NHS hospitial.

But they are correct about one thing - you are paying a bribe for prompt attention of the consultant
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
This is how I avoid paying or worrying about NHS waiting lists:



This is the self funding method. It is called, getting close to 50+ age bracket and avoiding the need for healthcare as long as possible.

Note the targetting of avoiding cancer and cardiovascular illnesss. There is method is my madness..... (I have been doing this for much longer than 2-3 years, think 10-15 years!, I am just getting better now at focus on key performance indicators)
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@Bigtipper,
Are those alcohol units/week hourly?
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@musher, I have been thinking about the link between alcohol and cancer this evening. The most terminal cancers all seem to be linked to alcohol. (or could be alcohol related). For example, oesophagus, stomach, liver, pancreas are all terminal cancers which have a very low survival rate. These are the main organs which alcohol targets. I do not think there is much of a surprise there. The one other most terminal cancer, lung cancer, is directly linked to smoking.

The alcohol units are average units per week as stated. That does not mean I do not occassionally drink 7 units in one day. It means that on average, over 6 months, I drink 6 units per week! I try to ensure there are no binges, but I fail sometimes.

In my younger days I drank more, and binged more. The last time I smoked was 2006, so it has been more than 10 years. This does not eliminate the risk of smoking related illness, but it reduces it dramatically statistically.

My oxygen saturation levels are very high at rest. (98% on average)

Some people need to watch sugar levels, and saturated fat levels. I measure mine, but find that I do not need to focus there as I tend not to have much volatility in those areas. I focus where I have volatility, or where I need to reduce levels (like salt)! So my KPIs might not be the same as a diabetic, or someone with a high BMI
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 snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
Jonpim wrote:
Following on:
The downside of Private Practice - there is far less scrutiny in Private Practice than in the NHS.
And also highlights the problem of general public trying to identify the optimum doctor to go to - Ian Paterson was thought by many to be one of "the top in his field".

There needs to be the equivalent of "Which" for Health.
Not CQC with its spreadsheets and silly targets
but a proper consumer forum to provide useful information.


Wimbledon Clinics are inspected by the CQC. We volunteer to do this- we could sit under the hospital's CQC. It's definitely not perfect but it rigorous. Our outcome data is monitored by the private hospital . All of our doctors are subject to annual appraisal. We all have to be revalidated by an independent process. We are scrutinised by the major insurers. We, in addition, rely on patients coming to us purely on reputation. Every patient we see has multiple choices to go elsewhere- unlike the NHS .
If there were dishonest practices going on in my clinic there is absolutely no incentive for that to be " overlooked". The problem in the private sector is that most are single handed practitioners. Working as a group we are all aware that our own individual reputation is dependent on that of the clinic- so there is plenty of scrutiny of each other.

I'm happy Wimbledon Clinics, and all the clinicians working with us, are able to hold our heads high and set the highest standards I know of in the private sector.

Jonathan Bell
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
I suspect that it is the scrutiny by major insurers, which has the most influence on private medicine. If some practices were blacklisted for example, this might have a significant effect.

Reputation, advertising, are as in the words of Niccolς di Bernardo de Machiavelli,

<requoted>

"So much depends on reputation – guard it with your life. Reputation is the cornerstone of power. Through reputation alone you can intimidate and win. Once it slips, however, you are vulnerable.”

Robert Greene, 48 Laws of Power: 5

Advertising however, is not reputation. Often it antagonises competition, and in some professions it is illegal by bylaws. However, it is accepted in modern day life to see firms of lawyers advertising for whiplash injury cases.

The FSA used to say that they could blacklist financial services individuals "if they had a reputation". In other words they could make it impossible for people who they decided had a "reputation" to work in financial services in a senior role. They have been found out, and no longer exist under that name. (as did their predecessors LAUTRO, PIA, etc etc)

If the supervising body keeps changing its name, it can distance itself from its past? It has a reputation...., and most of the people who worked there do too. Now it is overseen by the Bank of England. This is a new period, in which the Bank of England's reputation will be threatened by any crisis.
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Jonathan Bell, I am sure your setup is exemplary.
And this forum is full of your good outcomes.

However, I am not so optimistic about the ability of Appraisal and Revalidation to keep up standards - I bet Ian Paterson's appraisals were complimentary and his Revalidation fully up-to-date.

And i do question your statement: "Every patient we see has multiple choices to go elsewhere - unlike the NHS".
There is choice in the NHS.
The NHS Choices site is clear:
Quote:
"If you need to be referred as an outpatient to see a consultant or specialist you may choose the organisation that provides your NHS care and treatment (an outpatient appointment means you will not be admitted to a ward). You may choose whenever you are referred for the first time for an appointment for a physical or mental health condition.

You may choose any organisation that provides clinically appropriate care for your condition that has been appointed by the NHS1 to provide that service.

You may also choose which clinical team will be in charge of your treatment within your chosen organisation."

An increasing number of patients are now getting care in Private Hospitals paid for by the NHS.
See: https://www.bmihealthcare.co.uk/choose-and-book
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 You know it makes sense.
You know it makes sense.
@Jonpim,
if a criminal happens to be a doctor then then there are very few reasonable safeguards that can be put in place by a regulator that relies on self/ peer reporting. Any person,with intent to deceive for dishonest purposes, are good, by definition, at avoiding detection whatever their trade.
The insurers have, in the past, detected abherent practice but historically have been surprisingly poor about being thorough. I currently assist a well known insurer to scrutinise activity with the aim of detecting " outliers"

Jonathan Bell
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
I had BUPA (through the company) from 1980 up to last Summer, when I ended up having to take early retirement. I did use it for back surgery 3 years ago and a bit of physio.

The premiums got steeper and steeper (even with cutting back, to keep the price down) and things like Physio became harder to get. I haven't worked it out, but I'm sure that if I'd self insured, I'd have saved a lot of money....but one never does, unless very disciplined.

After I left work, I could no longer afford the hefty premiums, so stopped. It was a risk, as if my back needs treatment again, it will be an existing condition, so wouldn't get cover again...but I reckoned if I survived 7 or 8 years, I would have saved the cost of a back op, if going private.

As people have said, the problem with the NHS are the waiting times. In NI, Orthopedics has the longest waiting lists....3 or 4 years just to get seen.
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 Poster: A snowHead
Poster: A snowHead
Quote:

As people have said, the problem with the NHS are the waiting times. In NI, Orthopedics has the longest waiting lists....3 or 4 years just to get seen.


In Worcestershire the last couple of times I have needed treatment (one knee and two shoulders) it has happened within a couple of weeks.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
johnE wrote:
Quote:

As people have said, the problem with the NHS are the waiting times. In NI, Orthopedics has the longest waiting lists....3 or 4 years just to get seen.


In Worcestershire the last couple of times I have needed treatment (one knee and two shoulders) it has happened within a couple of weeks.

Blimey, I may have to move. Toofy Grin
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