Surgery and Outpatient Costs

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What you can claim for with County Medical

As with any health or private medical insurance policy, it is important to fully understand what is covered and what is not.


A hand-holding service to take you all the way to full recovery

Operations covered by County Medical policies include procedures identified by our doctors as being most likely to incur waiting times within the NHS and are shown in our Schedule of Procedures. These include the overwhelming majority of procedures that are undertaken in a private hospital under medical insurance schemes.

If you need surgery and it’s covered by your health plan, we will schedule it in our Private Treatment Network on your behalf, quickly and efficiently. If you’d prefer to use another hospital, County Medical will reimburse you up to the amounts on our published fee schedule. This is equivalent to what we would pay our network facilities.

As a doctor led organisation we can offer you the assistance of a senior specialist who can guide you throughout your fast-track treatment with a handholding service to take you all the way to your full recovery.

Please note we do not cover surgery for cancer in our standard policy. This benefit has to be purchased separately.

Outpatient Costs (Subject to upgrade being selected)

Consultations and Diagnostic Tests

This policy covers you for consultations and diagnostic tests up to the amount stated below. Contact us in total confidence on our claim helpline (available Monday to Friday) as soon as are aware you need to see a specialist and we will arrange this for you.

What you can Claim

Out-Patient Consultations Amounted Covered
Consultations and investigations Up to a combined maximum of £1,500 per person per policy year of usual and customary charges for all treatments covered in this section.
Diagnostic tests such as blood tests, ECGs, ultrasound scans, x-rays and biopsies
MRI and CT Scans

What you can Claim

Treatment Using Our Hospital Network Using Other Hospitals
Hospital charges for surgery, including accommodation, theatre fees and meals, nursing care, drugs and surgical dressings. Payment in full We will pay for treatment up to the amounts shown in our Approved Procedures.
Specialists fees Payment in full We will pay for treatment up to the amounts shown in our Approved Procedures.
Post-operative Physiotherapy Payment in full for up to two sessions per policy year. We will pay for treatment up to the amounts shown in our Approved Procedures for up to two sessions per policy year.

What a County Medical Plan Does Not Cover

Like all health insurance plans, there are some things that your membership doesn’t cover. The main exclusions are explained here but a full list can be found in our policy terms and conditions.

Your Plan Does Not Cover;

  • Treatment of medical conditions you had, or had symptoms of, before you joined.
  • Any treatment in the Accident & Emergency department stabilised and further management deferred as a planned procedure
  • Treatment of ongoing, recurrent and long-term conditions (chronic conditions).
  • Treatment of Cancer. If you have selected the optional cancer coverage then we will however pay cash benefits as shown above.
  • Kidney dialysis
  • Organ transplant
  • Cosmetic or lifestyle surgery
  • Drug or substance abuse
  • Professional and semi- professional sports
  • Any obesity surgery
  • Self-inflicted injuries
  • Sexually transmitted diseases
  • Congenital or genetic disorders
  • Mental health and behavioural disorders
  • Procedures on children under 2 years.
  • Routine pregnancy and childbirth.
  • Any treatment undertaken outside the United Kingdom (unless agreed in advance)
  • Professional and semi- professional sports
  • Complimentary medicine
  • Dental treatment
  • Experimental or unproven treatment
  • Infertility or contraception
  • Prevention and Surveillance –
  • Routine eye care
  • Out-patient drugs, dressings or medical appliances
  • Unauthorised claims, unless pre-approved by us
  • Activities not directly related to your treatment – such as any report writing or provision of certificates