NHS vs private physiotherapy – and BUPA vs Cigna

I have had multiple sessions of physiotherapy over the years for various joint problems. I’ve experienced both NHS and private physiotherapy. For my private physiotherapy I’ve dealt with both BUPA and Cigna.

NHS vs private physiotherapy

If you need physiotherapy you have two basic choices, you can either try to get it for free on the NHS or you can go private. If you go private you’ll either have to pay for it yourself or if your private medical cover it may be possible to get them to pay for it.

Referral letter

Getting NHS physio will in the first instance require a visit to your doctor / GP. You’ll need to get a referral from them for a course of treatment. If you are having NHS physio then the referral will generally dictate which physiotherapy practice you visit.

Sometimes you will need to be a bit assertive with your doctor if you want a physio referral. They may well fob you off by saying something like you should rest your leg, take some pain killers, lose some weight etc. They may be valid points but if your problem is long standing then seeing an expert is probably the best solution. Often the best way to get what you want from your GP is just to be clear – explain that you have a problem and ask if you can see an NHS physiotherapist.

If you want to see a physio via your private health insurance then the procedure is usually very similar – but will depend on how your private health insurance company operates. Many of them will require a doctor’s referral as well. In this case you’ll have to ask your doctor for a private referral letter. You can just ask them for this. As giving you a private referral doesn’t result in any cost for the NHS they should happily write the letter for you.

If you want to pay for private physio yourself then it is generally not necessary to see a doctor. You can book your appointment straight with the physio clinic.

Making the appointment.

With an NHS referral you’ll then have to make an appointment. Your referral letter should tell you who to call to do this. One of the disadvantages with NHS physio is that there will be a waiting list. It could be a number of weeks or even months before your appointment date.

Making a private appointment with health insurance will require you to get approval from your health insurance company before booking your physio appointment. However as your health insurance company may need the name of the physio company that you are using (to check that they deal with them), you should check with the physio company first to make sure they will treat you, and that they can charge your health insurance company for your treatment.

The policies that I’ve had with both BUPA and Cigna mandated calling them to get authorisation before booking the physio. On calling them they ask basic questions such as why you want physio. As long as they are happy with your answers they will approve a course of treatment.

The first time I used BUPA was several years ago for wrist and arm pain/numbness. BUPA authorised treatment up to a value of £1000. They gave me an authorisation code which they said was valid for six months. This authorisation is needed by your physiotherapist in order to claim back the costs of your treatment. When I used BUPA again several years later they gave me another code for treatment – but this time valid for treatment up to the value of £2000!

Cigna was quite different. My company was using a ‘managed health care’ plan. This meant that Cigna would keep a tight control over the amount of treatment they would give me. Again, once they were satisfied they gave me an authorisation code. With my Cigna plan it was only valid for 6 sessions. There didn’t seem to be any maximum cost associated with it but I checked that the amount that my physio was charging was acceptable.

After my initial 6 sessions were used up Cigna authorised a further 4. To get more physio would require seeing an orthopedic consultant which they would pay for. For the orthopedic consultant they would issue a code which would be valid for a single appointment. If an x-ray was required it would be covered if done in the same orthopedic consultant appointment, but I’d have to phone up again if they were booked in for a different appointment or if I needed an MRI scan.

As it turns out I did need an MRI scan – I called them up and they authorised the MRI scan and also authorised a follow up appointment with the consultant.

The treatment

The actual treatment was effectively the same whether I went with NHS or private physio.

Treatment consisted of an initial appointment where the physiotherapist asked lots of questions about my injury and manipulated my joints to try to make a diagnosis.

The time in other sessions was taken up with showing me exercises and stretches that I needed to do in my own time, and treatment – much of which was in the form of painful deep tissue massage. At some points they also used taping of the joints to hold them in the correct place, and ultrasound to stimulate blood flow.

Quick comparison

NHS – Go to doctor, get referral, book appointment and wait. Have a short amount of Physio.

BUPA – Go to doctor, get referral, get authorisation from BUPA, book appointment and see physio in next few days. Have as much physio as is covered by your policy. In my case £2000.

Cigna – Go to doctor, get referral, get authorisation from Cigna, book appointment and see physio in next few days. Have 6 sessions. Phone Cigna to authorise some more. Have 4 sessions. Phone Cigna to get authorisation to see orthopedic consultant. Consultant can then either recommend more physio or a different kind of treatment. Whichever is needed you’ll need to call Cigna at each stage to get authorisation.