Within the insurer's list, usually — and outside it, you pay the difference.

What the policy documents actually say

Insurers pay specialists' fees up to the limits in their own fee schedules. Aviva states that specialists' fees are covered up to the limits in its fee schedules and that hospital fees are only covered in full when using an agreed facility. A consultant charging above the schedule leaves you with the shortfall, which is the most common source of an unexpected bill on an otherwise valid claim.

AXA Health distinguishes between specialists it recognises and those it does not. For therapies it will pay a cognitive behavioural therapist only where a specialist is on its fee-approved list, and it says plainly that if you use a therapist it does not recognise it will not pay for the treatment — while offering to help find one whose fees it pays in full.

The Exeter's Guided specialist option makes the trade explicit as a product choice: a lower premium in exchange for the insurer directing you to a consultant rather than you choosing freely.

The practical route is to ask the insurer to confirm, in writing and before the appointment, that both the consultant and the hospital are covered and that the fees are within schedule. Consultants often practise at several hospitals, not all of which will be on your list.

Second opinions sit alongside this. AXA Health will help find an alternative specialist and pay in full, which is worth using when a recommendation is elective.

Questions to put to the insurer or broker

  • Is this consultant fee-approved, and at what rate?
  • Which of the hospitals they practise at are on my list?
  • What happens if their fee exceeds the schedule?

Related questions

Sources

  • Source: Aviva — Healthier Solutions Terms and conditions (2025-04), read 4 September 2026.
  • Source: AXA Health — Personal Health membership handbook, October 2024, read 4 September 2026.
  • Source: The Exeter — Private Medical Insurance — Insurance Product Information Document (Health+) (2025-10), read 4 September 2026.

The limit behind every answer here

None of this reaches a condition you already have. Cover is written for problems that arise after it starts, so anything you have symptoms of when you apply is excluded — permanently under full medical underwriting, or until a symptom-free period has passed under a moratorium. Chronic conditions are excluded by every insurer whose wording we hold. Figures quoted come from current policy documents and change at renewal, so check the document you are actually offered.

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