Can I use private health insurance for fibroid treatment?

Being told you're on a waiting list that is months or even years is a huge disappointment. You've finally got a resolution in sight, but it's still out of reach. If you have private medical insurance through work or a policy you pay for yourself, it may be worth checking whether you can use it for your fibroid care.

Depending on your policy, insurance may cover specialist appointments, investigations and treatments such as fibroid surgery. This can give you another route to care alongside the NHS.

But being insured doesn't automatically mean your fibroids, or every part of your treatment will be covered. Here’s what to check.

How does private health insurance work?

Private medical insurance, often called PMI, pays for eligible private healthcare according to the terms of your policy.

Most policies are designed to cover new, acute medical conditions rather than the ongoing management of long-term or pre-existing conditions. The Financial Ombudsman Service explains that private medical insurance commonly covers acute conditions but may restrict chronic conditions.

Depending on your level of cover, your policy could include:

• specialist appointments

• diagnostic tests and scans

• hospital treatment

• day-case procedures

• surgery

• follow-up appointments.

You may have limits on outpatient appointments, particular hospitals or consultants, and certain treatments. You may also have an excess, meaning you pay the first part of a claim yourself.

Are fibroids covered by private health insurance?

They can be.

If your fibroids require investigation or treatment and the condition is eligible under your policy, your insurance may cover some or all of your care.

For example, AXA Health's current specialist schedule includes procedures such as myomectomy and hysteroscopic resection of fibroids. Bupa also recognises consultants who specialise in fibroid treatment and procedures such as myomectomy.

However, this doesn't mean a particular procedure will automatically be covered. Your insurer will need to confirm that your condition, consultant, hospital and proposed treatment are eligible under your individual policy.

One of the biggest factors is whether your fibroids are considered a pre-existing condition.

What if I already had fibroids before my policy started?

This is where insurance can get confusing.

You don't necessarily need to have had a fibroid diagnosis for an insurer to consider the condition pre-existing. They may also look at whether you had related symptoms, investigations, medication or medical advice before your cover started.

For example, if you'd already spoken to your GP about very heavy periods before taking out your policy and were later diagnosed with fibroids, your insurer may look at whether those symptoms were connected.

Different types of underwriting also have different rules.

With moratorium underwriting, for example, a pre-existing condition may become eligible again after a specified period without symptoms, treatment, medication or medical advice. The rules and time periods vary between insurers.

And if you have health insurance through work, it's particularly worth checking. Some employer schemes use Medical History Disregarded (MHD) underwriting, where previous medical history may not be excluded in the same way.

So even if you already have fibroids, don't assume you're covered, but don't assume you're excluded either. Ask.

What should I ask my insurer?

Before booking private appointments or treatment, call your insurer and explain that you are seeking investigation or treatment for fibroids.

Ask:

• Is investigation and treatment of my fibroids covered?

• Do any pre-existing condition exclusions apply?

• What type of underwriting do I have?

• Does my outpatient cover include consultations and diagnostic scans?

• Do I need a GP referral?

• Which gynaecologists and hospitals can I use?

• If surgery is recommended, will I need separate authorisation?

• Do I have an excess or any other costs to pay?

• Are follow-up appointments covered?

If you've already been recommended a particular procedure — such as a myomectomy — give the insurer the exact details rather than simply asking whether they cover “fibroid treatment”.

How do I make a claim?

The exact process varies between insurers, but it will usually follow a few simple steps.

1. Check your policy

Find your policy documents or log into your insurer's app or website. Look for your underwriting terms, exclusions, outpatient allowance, excess and hospital list.

2. Get a referral

You may need a GP referral before seeing a private gynaecologist. Some insurers offer their own digital GP services, while others may accept a referral from your NHS GP.

Your insurer may ask for an open referral, which means your GP refers you to a type of specialist, such as a consultant gynaecologist, rather than one named doctor.

3. Contact your insurer

Do this before booking treatment.

Your insurer will check whether your claim is eligible and tell you which specialists and hospitals you can use. If authorised, you'll normally receive a claim or pre-authorisation number.

4. See your specialist

Your consultant may recommend further scans, tests or treatment.

If they recommend surgery or another procedure, contact your insurer again before going ahead. Your original authorisation may not automatically cover the next stage of treatment.

Confirm that the specific procedure, consultant and hospital are covered and ask whether there is anything you will need to pay yourself.

Keep your authorisation number and any confirmation emails or letters.

Which insurers offer this type of cover?

Major UK private medical insurers include Bupa, AXA Health, Aviva and Vitality Health.

All provide policies that can cover specialist and hospital treatment for eligible medical conditions, but there isn't a simple rule that says one insurer “covers fibroids” and another doesn't.

What matters is your particular policy: when your symptoms began, how the policy was underwritten, your outpatient allowance, hospital list and the treatment your consultant recommends.

This is especially important with workplace insurance because your employer may have negotiated different levels of cover.

Already insured? It's worth checking

If you have fibroids and already have private medical insurance, find out what you're entitled to before assuming private treatment isn't an option.

Start by checking your policy and speaking to your insurer. Be specific about your fibroids, symptoms and any treatment that has already been recommended.

Private medical insurance isn't an option for everyone and it doesn't replace the NHS. But if you already have eligible cover, it may provide another route to specialist assessment and treatment.

And if your insurer says your fibroids aren't covered, ask them to explain why. If you believe the decision doesn't match your policy terms, you can make a formal complaint and, where appropriate, take an unresolved complaint to the Financial Ombudsman Service.

Useful resources

• Bupa – Making a health insurance claim

• AXA Health – Accessing treatment and making a claim

• Aviva – Understanding medical underwriting

• Financial Ombudsman Service – Private medical insurance

• Financial Ombudsman Service – Pre-existing medical conditions

The Leio takeaway

If you already have private medical insurance and need treatment for fibroids, use the cover you've got and find out what's available to you.

Start by checking your policy, getting the appropriate referral and speaking to your insurer before arranging private care.

The important thing isn't to assume you're covered, or assume you're not.

Ask specifically about fibroids, your outpatient benefits, your underwriting terms and the treatment being recommended. And get authorisation before you proceed.

Private medical insurance won't be an option for everyone, and it doesn't replace the NHS. But for women who already have eligible cover, it can provide another route to specialist assessment and treatment.

This article provides general information about private medical insurance in the UK and is not medical, financial or insurance advice. Insurance policies and eligibility vary. Always check your individual policy and obtain authorisation from your insurer before arranging private treatment.