Medical Treatment

Dependent on authorisation, we can support the full cost of any treatment on our approved procedures in our treatment network. This includes:

• fees for surgeons, anaesthetics, operating theatres, accommodation, nursing, medical admission, and specialist consultants;

• as well as pre-operative tests and post-operative physiotherapy, dressings or other consumables that are necessary.

Please note we won’t provide funding if you proceed with any appointments without our authorisation.

You must contact us for authorisation before you proceed with any appointments. We’ll ask you to provide a copy of a consultant’s report confirming the CCSD code for the procedure required and details of the NHS wait time for your appointment. Please refer to our current wait times or call us for guidance on how your NHS wait time is used to help determine whether your request for services could be supported.

Where we’re able to authorise your request, you’ll be provided with authorisation to make your appointments at an appropriate clinic or hospital we propose.

Please refer to our approved procedures and ensure you always contact us before arranging any appointments to find out whether we can help you.

Types of procedures not on our approved procedures list include:

This list isn’t exhaustive and is subject to change.
 

• We can only provide treatment from our approved procedures list. Anything not included on our approved procedures list is excluded. Any treatment where, in our view, it may be safer for you to remain on the NHS waiting list, for example, complex surgeries that may lead to ongoing consultations and treatment is excluded. Examples of excluded procedures include surgeries related to cancer, heart or brain conditions, joint replacements or anything not on our approved procedures list.

• All treatments we authorise must take place within eight weeks of our initial authorisation. We won’t settle any expense that you incur more than eight weeks after initial authorisation.

• We won’t pay for services relating to the same medical condition on the same body area within two years of us first authorising support.

• NHS wait times will be considered before authorising any treatment services and are subject to change. Please refer to our guidance on how your NHS wait time is used to help determine whether your request for services could be supported.

• We’ll only authorise Physiotherapy, Medical Diagnostics or Treatment assistance for one set of health concerns at any one time.

• We won’t pay for monitoring of any ongoing condition, including consultations or treatment for the same reoccurring symptoms.

• We’re unable to pay for any treatment services if you’re not a UK resident.

• You should always contact us before arranging any appointments to find out whether we can help you.

• Whilst Benenden Health provides authorisation for the treatment services you require at one of our approved hospitals, it may be that following a clinical review, a decision could be made that it isn’t appropriate to provide the treatment support you require. The clinicians at the facility will be able to guide you back to your GP or the NHS for continuation of the care you need.

• We are unable to provide any authorisation for treatment services at Benenden Hospital or within the Bupa network where an allowable and excluded CCSD code is required to be undertaken at the same time.

To request access to treatment please refer to our guidance on how NHS wait times may determine whether your request will be authorised.

Our approved procedures focus on treatment likely to have an immediate positive impact on quality of life without requiring prolonged hospital stays or ongoing treatment and care and are considered less complex. For information on how our Medical Advisory Panel of expert clinicians support us in agreeing which procedures are approved please review our list of procedures. 

As our services are provided on a discretionary basis and are subject to the resources we have available, we may change the approved procedures, including but not limited to Procedures of Limited Clinical Value. Some routine treatments are now described as Procedures of Limited Clinical Value (PLCV) by the NHS. These are procedures which national experts have suggested have only limited or temporary benefit and which are not felt to be necessary to maintain good health.

This list is not exhaustive and is subject to change. Anything not on our list of our approved procedures is excluded.