Examples
The following examples have been created to demonstrate how PatientChoice works and may not represent actual cases.
PatientChoice Access
Example One - Knee replacement
Mr Murray, 52, develops pain around his left knee and visits his GP.
| Step 1: | The GP refers Mr Murray to a private orthopaedic specialist for assessment. |
| Step 2: | Prior to seeing the specialist Mr Murray contacts PatientChoice, who send Mr Murray a claim form to take with him to the consultation. At the consultation, which costs £120, the specialist recommends an MRI scan costing £650 and a follow-up afterwards, costing £90. Other than Mr Murray having to pay the first £100 (his excess), PatientChoice would cover the cost of the consultations (up to an annual maximum of £300) and the cost of the MRI scan (up to an annual maximum of £700). |
| Step 3: | At the follow-up consultation Mr Murray is advised that he needs a knee replacement. PatientChoice confirm that a knee replacement is a covered procedure in 'Band 6' category with a benefit of £ 10,000 for treatment in a private hospital or £2,500 on the NHS. |
| Step 4: | Mr Murray chooses to have his treatment done privately and asks the treatment sourcing service to negotiate a fixed-price package on his behalf at the local private hospital, including some post-operative physiotherapy sessions. |
| Step 5: | A fixed-price of £8,500 is negotiated on Mr Murray's behalf and he undergoes the procedure soon afterwards. |
| Step 6: | PatientChoice sends Mr Murray a cheque for the unused surplus of £1,500, which he uses to pay for a holiday. |
If for any reason the fixed-price treatment was to cost £10,500, Mr Murray would have to pay £500 from his own resources as the benefit payable by PatientChoice Access would be fixed at £10,000 for this procedure.
Example Two - Cancer
Mrs Symonds, 60, has a stomach complaint and on referral from her GP visits an NHS gastroenterologist. The consultant recommends a colonoscopy.
| Step 1: | Mrs Symonds contacts the PatientChoice Customer Helpline, who confirm that colonoscopy is a covered procedure in the 'Band 2' category which provides a benefit of £1,500 if carried out privately or £250 if carried out on the NHS. PatientChoice pays Mrs Symonds £50 for the NHS consultation. |
| Step 2: | A local government initiative has reduced NHS waiting times for colonoscopies and so Mrs Symonds has the procedure carried out on the NHS and receives a cheque for £250 from PatientChoice. |
| Step 3: | Unfortunately, a cancerous growth is found during the colonoscopy. At a follow up NHS consultation, for which she receives a further £50, Mrs Symonds is advised that she needs a bigger operation to remove part of her colon. She decides to have the procedure carried out in the private sector. PatientChoice confirm that the procedure is in the 'Band 5' category and provides her with a budget of £6,000 for private care. |
| Step 4: | Mrs Symonds uses the PatientChoice treatment sourcing service, which negotiates a £5,200 fixed-price package for her care at a private hospital. |
| Step 5: | Mrs Symonds has her operation carried out successfully and does not require further treatment. PatientChoice sends Mrs Symonds a cheque for £800, which is the unspent surplus from her £6,000 entitlement. |
The Hospital Treatment Plan
Example Three - Knee ligament repair
Mr Brownlow, 32, has knee pain 3 weeks after twisting his knee while jogging on a weekend. He decides to visit his GP who refers him to an orthopaedic consultant. The consultant advises him to have an MRI scan of the affected knee. Mr Brownlow pays to have his MRI scan done privately but uses our treatment sourcing service to reduce the price of the scan significantly.
| Step 1: | The MRI shows he needs his internal knee ligaments repaired using key-hole surgery and Mr Brownlow contacts PatientChoice. |
| Step 2: | PatientChoice confirms that the claim is covered as a procedure in the 'Band 4' category for which PatientChoice will cover £3,000 if the operation is done privately or £500 if the operation is carried out by the NHS. |
| Step 3: | Mr Brownlow chooses to have his damaged internal knee ligaments repaired at a private hospital as he is in some discomfort and the private hospital is able to treat him quickly. |
| Step 4: | Mr Brownlow has his operation and PatientChoice pays the hospital £2,350 leaving Mr Brownlow with a cash lump sum of £650, which he uses to help pay for his private consultations, his MRI scan and other costs associated with his recovery. |
Example Four - Hysterectomy
Mrs Shields, 40, is referred by her GP to a gynaecologist who diagnoses Mrs Shield's condition as requiring a hysterectomy.
| Step 1: | She contacts the PatientChoice Customer Helpline who confirm that the claim is covered as a procedure in the 'Band 5' category, with a benefit of £6,000 if done privately or £1,500 if carried out on the NHS. |
| Step 2: | Mrs Shields chooses to have her treatment under the NHS as the hospital is much closer to her home and has a short waiting list. |
| Step 3: | The operation is carried out under the NHS and Mrs Shields receives a cheque from PatientChoice for £1,500. |