Safe & Secure: Working with Private Medical Insurers, by Dr Esther Cole

Although world-class, waiting lists for NHS mental health services are at an all time high. Patients and commissioners are, more than ever, seeking options for private sector health services. 

Some NHS Trusts are no longer funding some mental health services. As an example, Derbyshire Healthcare NHS Foundation Trust announced to the BBC in October 2024, that they are to stop providing talking therapy services for nearly 30,000 people.

Met with rising living costs and an increase in staff burnout since the pandemic, many clinicians are turning to private work to address monetary and clinical shortfalls in the system. 

There was a time, before social media became popular, when setting up an independent practice having just qualified from doctoral training, was taboo. It took place in secret, before colleagues' websites even existed and referrals were kept quiet and whispered word of mouth. 

There was a sense of betrayal in leaving the NHS. Colleagues once frowned upon this, with a residual culture of judging psychologists, and other professionals in private practice, as money-grabbing, mercenary and extortionate. 

Historically there's been a background of secrecy. So, although PMIs provide the life-blood for most private psychology practices, I think this is why working with private medical insurers (PMIs) has always been an enigma. 

I designed this webinar "Safe & Secure: Working with Private Medical Insurers" to make working with PMIs more transparent. It was initially designed, with the psychologist in mind, who is new to private practice, and who needs extra money on evenings or weekends.

I later created a PMI hierarchy of needs like Maslow's: "PMI: Psychologists' Skills Development Hierarchy" for more seasoned clinicians and business owners who might also want to develop in this area.

• Setting Up
  The hierarchy shows that at the base of the pyramid are basic needs, like learning how to register with Healthcode - the private practice register; and other PMIs, and attracting clients through directories. 
• Accessing The Policy
  The free consultation, or initial onboarding of adult and child clients was discussed. The importance of knowing key PMI parameters - from the outset in order to access the policy was highlighted, such as if an excess was owed, how many sessions were funded and the maximum funding available and over which timeframe?
• Claiming and Invoicing
  There are numerous ways to invoice as well as numerous pitfalls if errors are made, and my aim was to make delegates feel more confident claiming, chasing, leveraging late fees and invoicing more effectively, efficiently and frequently for the work they did.
• Negotiating
  Further up the skills hierarchy, I also bore in mind senior psychologists thinking of hiring Associates, and psychology companies met with rising costs. The webinar was designed to help them look at how to increase fees and negotiate with PMIs for the level of work they do. 
  
  It also revealed how the independent psychology community have worked together with Open Letters to PMIs, to re-negotiate fees, educate insurers and make PMI for mental health treatment more accessible to the public.
• Income Protection Insurance
  For seasoned clinicians who were experienced in the other skill areas in the hierarchy, I brought in my experience of income protection claim requests, illustrated by a practice example. 
  
  There are rare, but kick in when your client's company sick pay has run out, and they need to claim a portion of their salary through insurance. This can be panic-stricken and it is difficult to know what to write in support of your client without an occupational psychology and rehabilitation focus in the report.
• Ethical Considerations 
  The webinar ended with plenty of ethical considerations in mind for our policy holders with lower levels of insurance cover. Not everyone with private medical insurance comes from a privileged background. 
  
  Often employers of even students, or one policy holder in a household, can grant access to others on lower incomes.
  
  People now prefer in-person sessions and are finding their insurance will not always cover them to see a doctorate trained psychologist in person. What's more, most insurers do not allow clients to top up fees. 
  
  Children, families and vulnerable adults often bring indirect work with parents, schools and other parts of the system through safeguarding, and other assessment and intervention, which are not always funded by PMIs. 

The webinar ended with a nod to working with a range of UK and international private insurance companies for a spectrum of clients with policies ranging from £1000 to £5m; offering to charge less to clients with less funding, as we do at Lifespan Psychology - The Diverse Practice®.

After all, what is the state of mental health services coming to when even the so called "privileged" are being turned away?

About the author

Dr Esther Cole is a Consultant Clinical Psychologist, Author, Coach, Podcaster and Founder of Lifespan Psychology - The Diverse Practice® in London, UK