Patients & Families
1. Do I need a referral from my GP?
2. How can I pay for my treatment by The One Health Group?
3. What do I need to do to get authorisation from my insurance company?
4. How do I find out the qualifications of my consultant?
5. Will I have the same consultant for my outpatient appointment and procedure?
6. What appointments will I need to attend before I undergo my surgery?
7. What happens if I need to change the date for my operation?
8. What happens if I am taking medication?
9. What will happen before and after my procedure?
10. Do I need to arrange my own physiotherapy?
11. How long after my operation will it be before I can travel safely by air?
12. And finally! A note from us!
1. Yes, we would recommend that you do need a referral from your GP.
Basically, we would recommend that you do need a referral from your GP.
If your operation is to be paid for by a medical insurance company they will require that a referral is obtained before they will approve any treatment.
If you are going to pay for your operation yourself a GP referral is not absolutely necessary although we would encourage you to obtain one as this will contain important medical information which will help your consultant advise the best treatment for your condition.
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2. How can I pay for my treatment by The One Health Group?
Payment for the operation falls into two broad categories, private medical insurance company or self-pay. The details of the arrangements for admission under these two schemes are outlined below. This can sometimes be confusing and so as to avoid any misapprehensions please feel free at any time to contact One Health Group for further guidance.
(i) Procedures Underwritten by Private Medical Insurance
In general there are three major payments that need to be made for a surgical procedure:
Payment to the Surgeon
Payment to the Anaesthetist
Payment to the Hospital
Except on rare occasions if you have private medical insurance you as a patient should not need to pay any sum directly yourself for day case and in-patient procedures. As long as the three parties above have your insurer’s details and you have obtained authorisation from your insurance company to proceed with the operation, invoices can and usually will be sent directly to the insurer for them to pay all three parties directly. Occasionally an invoice may find its way to you, if it does do not pay it but pass it onto your insurer for payment.
If one of the three providers above has not been paid after a certain period you as a patient may receive a “reminder letter”. Again please do not pay these but refer to your insurance company who will advise you as to whether the invoice has been paid etc. They will let you know if you are responsible for any payments, e.g. the payment of a “voluntary excess” as indicated in your private medical insurance policy documents.
All large organisations can and do make mistakes and private medical insurance companies are no exception. By and large however they are very accurate and sympathetic to queries and problems but if you feel they are wrong please say so.
(ii) Self-Pay Treatment
Many patients choosing private health treatment are not insured but wish to pay themselves for their treatment – this is termed “self-pay”.
There are some important differences in the payment for treatment for self-pay as opposed to treatment underwritten by an insurance company, and if you are considering self-pay this should be clearly understood.
For day case and in-patient procedures, the total cost of that procedure is bulked into one item called a fixed price package. We will code the operation as to its complexity prior to the operation (the OPCS code) and from this a package price will be formulated to cover costs of:
All in-patient hospital costs, including a short supply of drugs to take home after the operation.
All surgical costs.
All anaesthetic costs.
The cost does not include pre-operative consultations but does include ONE post-operative consultation with our surgeons.
The price given to you for this fixed price package is guaranteed and there will be no further costs to you other than treatments such as out-patient physiotherapy. Pre-operative assessment costs (e.g. for knee replacement) are included in this cost. Should the procedure be more complex than expected, the costs will not be passed onto you by any of the three parties above.
It is of the great importance that you understand and accept the terms and conditions of the contract offered to you by the hospital. You will need to check with them for specific operations but in general there is effectively a “30 day guarantee” associated with each procedure. If there is a complication within this period the hospital by and large will fund the cost of any further tests and treatment. However after this period they will not fund any further tests or treatment that you require.
A good example is a fixed price package for a knee replacement. If in the first 2-3 weeks a patient develops an infection or a deep venous thrombosis (blood clot in the calf) then the costs for tests and treatment with the consultant, anaesthetist and hospital fees will be covered by the hospital. However if after 6 months or 3 years the knee is found to have a problem (loosening, infection etc) then the hospital will assume no responsibility for the management of that complication. Basically you are an NHS patient again and you can then either manage the problem within the NHS or elect to pay again to have the complication managed privately.
For an episode of self-pay treatment, in general you will pay the hospital for the costs of all three parties (i.e. surgeon, anaesthetist and hospital costs). The hospital will then reimburse the surgeon and the anaesthetist. The only costs in excess of this payment are for consumables you make whilst in hospital e.g. newspapers, telephone calls etc. The hospital can give you details about how you can pay. Credit card facilities are available which is usually the easier or otherwise by cheque.
Please note: For the sake of clarity and avoidance of doubt the hospital will require payment from you in advance of your admission.
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3. What do I need to do to get authorisation from my insurance company?
It is very important that you personally obtain authorisation from your insurance company before you make an appointment to see one of our surgeons.
The arrangements for obtaining medical insurance authorisation varies from company to company but it would be safe to say that they all will require that you to inform them of what is going on.
Usually the authorisation process is fairly straightforward. Most insurance companies now authorise an episode of surgical treatment by telephone but occasionally forms will need to be filled in both by you and your surgeon. They will advise you of this.
Please send any forms requiring completion by one of our surgeons to the One Health Group 131 Psalter Lane, Sheffield S11 8UX. There is no charge made for this service. Your GP may occasionally also have to complete part of the form and you may be charged for this service by him/her.
Once you have arranged an operation the best thing to do is to telephone your insurance company and let them know the following information, which usually consists of:
The name of the Hospital, e.g. Thornbury Hospital
The name of the Surgeon, e.g. Mr Derek Bickerstaff
The name of the Operation
The OPCS code, which we will give you
The name of the Anaesthetist
The estimated length of stay
Surgeons from One Health Group and all the Anaesthetists working with us charge in accordance with the insurers published schedule for insured procedures, and on this basis there are no “surcharges” for you to pay other than the “voluntary excesses” you have already agreed with your insurance company. In other words as long as you have obtained authorisation from your insurance company to proceed, they will cover the cost of the entire procedure unless your policy specifically states otherwise.
If you have any queries about the authorisation process please feel free to ring our advisors on 0845 606 6859 who will be happy to help you. Alternatively you can email kathryn.hall@onehealth.co.uk or fax on 0114 2505523.
The legal basis of the relationship between surgeon/anaesthetist and you when you arrange to have an operation on a privately funded basis is that you are effectively entering into a contract between the surgeon, anaesthetist and hospital, and you at the end of the day are the person ultimately responsible for any charges to all three parties.
This emphasises the importance of the authorisation process with your insurance company, surprisingly it is in most cases very straightforward and quick if you have all the right information.
We (surgeon/anaesthetist/hospital) on our part can reassure you that as long as the insurance company has given you authorisation to proceed, our fees will be met in full by the insurance company involved as long as your policy does not say otherwise. There should be no charges to you other than agreed excesses or where your insurance policy requires you to pay a proportion of the treatment costs.
In general terms (and again please check with your insurance company) all day case and in-patient treatment is fully reimbursable and the costs are not taken from any annual allowances. There is thus no “financial limit” on the costs reimbursed for such treatment, again as long as your insurance policy states as such.
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4. How do I find out about the qualifications of my consultant?
The One Health Group website details the qualifications and experience of every one of our surgeons.
Please click on the link to obtain details of your chosen consultant here.
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5. Will I have the same consultant for my outpatient appointment and procedure?
Yes. All our surgeons believe that continuity of care and open consistent communication is of paramount importance to the successful and speedy recovery of our patients.
Our surgeons have a policy of communicating with you fully and keeping you informed of your medical status. All initial consultations and most follow up visits generate a letter to your GP and/or Physiotherapist.
We will send you a paper copy of that letter.
We will also send you a copy of the GP letter associated with your operation, again by paper.
Repeated studies have demonstrated that patients do not often “take in” most of the details of the condition and/or operation explained to them at the time of consultation. This is normal and affects everyone. It applies when one goes to see any professional, e.g. solicitor or an accountant. For this reason we send you copies of consultation notes for your review.
Most patients find receiving copies of these letters useful. By the very nature the letters often contain medical words which often are not readily understandable to the layperson. If you find any of the wordings difficult to understand please do not hesitate to e-mail or contact us for an explanation. We appreciate that some medical words sound quite worrying but usually this is not really the case. Any data within the letters and notes should be explained to you at the time of consultation or post-operatively anyway, but if you feel that something has not been explained to you please do not hesitate to contact us.
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6. What appointments will I need to attend before I undergo my surgery?
You will be invited to attend an outpatient clinic where you will meet the surgeon who will perform your operation. This will give you an opportunity to ask any questions that may be concerning you and to discuss in more detail what you should expect before during and after your operation. Your surgeon will also use this opportunity to undertake any further diagnostic tests that they may feel are necessary.
For certain operations (e.g. knee replacement) our Hospital partners will also invite you to come up to the hospital for a pre-assessment a week or two prior to the operation.
The purpose of the pre-assessment is to ensure that there are no conditions you have that would prevent us proceeding with surgery (e.g. urine infections). The nurse will take all the tests that are necessary and also give them the opportunity to discuss the finer points and practicalities of your stay in hospital. Most patients find this useful.
Both our Surgeons and our Hospital partners take hospital acquired infection very seriously and take active measures to prevent it. This includes MRSA but other infections are also possible and we take active steps to prevent them. One of these steps is to screen patients coming into hospital for MRSA, i.e. to see if you have MRSA on your skin, nose etc prior to coming into hospital. If we find that you do we may need to postpone your operation and give you treatment to eradicate it. We hope you agree that this is a sensible policy to try to minimise any occurrence of MRSA at the Hospital you have chosen.
The costs of the pre-assessment are covered in your in-patient costs if you are privately insured or in your fixed price package if you are a self-pay patient.
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7. What happens if I need to change the date for my operation?
On rare occasions either you or your surgeon may need to change the date of your forthcoming operation.
If you wish to change the date of your operation for medical, social or employment reasons, you are very welcome to do so, but please let our staff know as soon as possible. There are no financial penalties for doing so. We will make every attempt to arrange a new date at the most suitable time for you but please be aware that our operating lists are often full in the 1-2 weeks prior to surgery. However, we can usually accommodate your specific needs.
Please also be aware that on (rare) occasions your surgeon may need to postpone your operation. This is usually done at some length away from the date but occasionally we may have to cancel at very short notice, usually for clinical reasons. If this is the case we will make every effort to accommodate your needs in arranging a future date. We would stress that such an eventuality is rare. If an operation date needs to be re-arranged our staff will arrange to contact you by telephone or by a letter.
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8. What happens if I am taking medication?
(i) In general
Your consultant will ask you if you are taking any medication during your outpatient appointment. It is extremely important that you give as much information as you can so that your consultant can make an informed clinical decision on what action needs to be taken.
(ii) Diabetes
If you are diabetic (insulin dependant or on tablets) your operation and anaesthetic will need to be managed carefully. Please make sure you let your consultant know if you are diabetic and they will advise you of what to eat, drink and what treatment to take prior to your operation.
(iii) The Oral Contraceptive Pill and Hormone Replacement Therapy
Certain types of oral contraceptive pill and hormone replacement therapy increase risk of deep venous thrombosis after an operation. For this reason we often advise that you safely and appropriately come off these medications. Please let your surgeon know beforehand if you take any of these medications and they will advise you what to do.
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9. What will happen before and after my procedure?
(i) What Should You Do the Day Prior to the Operation?
Essentially you can do whatever is your normal routine and you can eat, drink etc as per normal. However it is sensible to avoid too much alcohol or rich/spicy foods the day prior to an operation.
(ii) What Should You Do on the Day of the Operation?
The default time to come into hospital for your operation is 7 am for a morning procedure or 11 am for an afternoon procedure. With a morning admission you should starve from midnight, i.e. have nothing to eat or drink at all that morning. With a midday admission you are allowed to have a light early breakfast (e.g. tea and toast) up to 7.30 am.
If you take regular medications, e.g. blood pressure tablets, it is safe to take them with a sip of water in the morning.
If you are diabetic please make sure you inform your surgeon of this and they will individually advise you as to what dose of insulin or diabetic medication you need to take.
We understand that some patients may have restrictive schedules or have to arrange childcare etc. If you wish for any particular admission time please ring our PA’s to request this two days prior to your operation. They will do everything they can to accommodate your request but please be aware that certain cases, e.g. children and diabetics, need surgery towards the start of an operating list.
(iii) Day Case Patients – After the Operation
If you are due to go home on the day of your operation this will usually be 4-5 hours after the operation.
You will ALWAYS be seen by your surgeon after your operation.
Our nurse assistants will ring you after surgery to check how you are and answer any queries, please make sure we have the telephone number where you will be on the day following surgery. The hospital may ring you as well.
(iv) Overnight Patients – After the Operation
Our surgeons will always come to see you after your operation and in fact all the days you remain in hospital. There are occasions when they will be out of the city at meetings or on leave. We try to schedule operations such that this is reduced to a minimum. If they are away you will be told of the event and we will organise a colleague to cover. Nearly always your surgeon will available for advice by phone in any event.
(v) Once You are Home
If you feel there is anything “going wrong” once you go home after your operation you are welcome to contact your surgeon directly.
If there is a query/emergency during office hours (9 am to 5 pm Monday to Friday) please contact us on 0845 6066859. You can also contact me by email via my PA on kathryn.hall@onehealth.co.uk
If there is an emergency outside normal working hours please contact the Duty Nursing Sister on the ward you were on at the Thornbury Hospital on 0114 2661133. The Sister will be able to contact your surgeon.
If your surgeon is away we will always have another Consultant who covers their practice who is available for advice and/or consultation.
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10. Do I need to arrange my own physiotherapy?
Most orthopaedic operations benefit from physiotherapy before and after the operation, as well as during your hospital stay.
If physiotherapy is indicated after and/or before your operation this will be arranged for you.
Although your operation will be performed in one of our regional centres, out-patient physiotherapy need not necessarily be at the particular hospital where you had your procedure. We have a close relationship with a large number of physiotherapists in Rotherham, Doncaster, Chesterfield, Wakefield, Worksop and Barnsley as well as the London, Berkshire, Derbyshire and Surrey regions. We can organise your physiotherapy with one of these units.
We normally liaise directly with the physiotherapist you have chosen to see and pass on your medical details so that your treatment can be optimised.
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11. How long after my operation will it be before I can travel safely by air?
(i) Flying and Surgery
As you may be aware flying on an aircraft carries with it a small but definite risk of deep venous thrombosis (clots in the legs). When flying we would recommend that you always take a low dose Aspirin (75 mg once per day) for 5 days prior to the flight, all the time you are at your destination and for 5 days when you return. We would also recommend that you wear compression flight socks when you travel by air.
Having an operation and flying carries an increased risk of deep venous thrombosis. If you anticipate flying in the 2 weeks prior to surgery or for the 6 weeks after surgery please inform your surgeon and they will individually advise you what to do and whether it is advisable to fly or postpone the operation.
In general terms we would advise avoiding flying;
After non major surgery, e.g. arthroscopy, for 2 weeks if short haul or 6 weeks if long haul
After major surgery, e.g. knee replacement, for 6 weeks if either short or long haul
However if you need to fly in that period this is usually possible. Your flight will need to be covered with you taking anticoagulant injections which we can arrange for you. How long and how much is different between patients and we will advise you of this individually.
(ii) Driving, Time from Work after Your Operation and Other Social Issues
Your recovery period will vary dependant upon the operation you have undertaken. Please feel free to ask our surgeons how long you should expect to be off work after your operation, when you should be able to drive again and any other occupational/social query you have.
If you need a sickness certificate we will willingly supply this to you at no cost.
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12. And Finally! A note from us!
The Stress of Operations
Any operation with or without a general anaesthetic is a very stressful event for everyone. You may regard clinic and hospital staff as not appreciating how important an operation is to a patient’s wellbeing and how stressful it can be, but most staff do and we certainly do.
If you have any queries, feel we made any errors or have any comments to make please contact us by phone, letter or email. You will receive an individualised response.
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