If your private medical insurance runs out during treatment

If your private medical insurance (PMI) funding runs out, you usually have options. What happens next will depend on your policy and your clinical situation.

Check why your funding has stopped

Contact your insurer as soon as possible to understand:

• why funding has ended
• whether any part of your treatment is still covered
• if there is a review or appeal process

Insurance policies vary, and decisions may depend on your specific treatment and level of cover.

Speak to your consultant or care team

Your consultant can help you understand:

• what treatment is still needed
• whether there are alternative options
• the likely costs of continuing privately

They may also provide information to your insurer if you are asking for a review or appeal.

Decide how you want to continue your care

You may have one or more of the following options.

You can choose to pay for your treatment yourself.

Before deciding, ask your provider for:

• a clear estimate of total costs (which they must provide under the CMA Private Markets Investigation Order 2014)
• details of what is included and not included
• any available fixed-price packages or payment plans

You may be able to continue your treatment in the NHS (if medically needed)

This usually involves:

• a referral from your GP or consultant
• joining an NHS waiting list

Your care team can explain how this would work and what to expect. Even if you have started treatment, you will not be able to jump up the queue and will be assessed on clinical need by the NHS.

When you transfer to NHS care, you may be allocated to the care of another consultant’s team, or you may end up staying with the same consultant, depending on waiting lists and consultant availability. There is no obligation on the hospital to allocate you to the same consultant. In receiving NHS care you may not have as much direct involvement from your consultant and may receive more of your care from the wider clinical team.

If you think your treatment should still be covered, you can:

• ask your insurer to review the decision
• provide any additional clinical information from your consultant

Your insurer should explain their process for this.

What to expect during this time

• You should be told in advance if insurance payment is due to stop
• Your care team will usually help you understand your options
• Steps are normally taken to avoid sudden disruption to essential care

If you are unsure, ask your consultant, provider or insurer to explain what will happen next.

Get help if you need it

If you are unsure about your options, you can:

• speak to your insurer
• ask your consultant or hospital team
• contact your GP for advice on NHS care

Important to know

Insurance cover differs between providers and policies.

It’s important to ask questions if anything is unclear, especially before you start treatment.