How UK consultants really set self-pay vs PMI fees — and why Bupa members sometimes pay more out of pocket than cash payers

Every senior UK consultant runs two fee schedules — self-pay and PMI-recognised. The PMI schedule is capped by the insurer; the self-pay schedule is not. Sometimes it is the cash payer who wins.

The short answer

• UK consultants operate two fee schedules: PMI-recognised (capped) and self-pay (uncapped)
• Bupa's fee schedule averages £220 per initial consultation; the same consultant may charge a cash patient £275
• Where PMI shortfalls arise, the member pays the difference — sometimes more than the equivalent self-pay bill
• Full disclosure of the consultant's fee status is a two-minute conversation almost nobody has upfront

Two fee schedules, one consultant

The pricing world inside a private consulting room is not a single number. Every senior UK consultant maintains at least two published fee schedules: one that matches what each of the major PMI insurers has agreed to pay (the 'recognised' schedule) and one that they charge to self-pay patients. Both are legal, both are visible on request, and the gap between them varies from £15 to £120 per interaction depending on speciality and geography.

Average initial consultation fees, London 2026

• Consultants operating a shortfall-fee policy for insured patients: ~38% (PremierPMI consultant survey, London 2025)
• Average shortfall billed to Bupa member per consultation: £38
• Median annual out-of-pocket for a member of a fee-shortfall consultant: £340

Why the gap exists

Insurers publish their fee schedules annually and negotiate directly with high-volume consultants for volume-based discounts. The consultants who accept the insurer schedule in full are 'fee-assured' or 'fee-approved'; the consultants who bill above the schedule pass the shortfall to the patient. Consultants argue — accurately — that the insurer schedules have not kept pace with practice costs (secretarial staff, indemnity, imaging equipment). Insurers argue — also accurately — that the schedules are indexed and reviewed annually. The patient sits in the middle of that argument, and the shortfall lands on their invoice.

"The single question I tell every client to ask their consultant's secretary on the first phone call: 'Are you fee-assured for my insurer?' A yes means zero out-of-pocket. A no means find another consultant, negotiate the fee down in writing, or accept a shortfall you can budget for." — Tumaris, Director, PremierPMI

The paradox — self-pay sometimes wins

For a straightforward two-consultation, one-scan pathway (e.g. a mild orthopaedic complaint that resolves with physio), the total cost is often lower on self-pay than on PMI plus consultant shortfalls. Add in the PMI excess (£100–£500 per policy year), and a self-pay pathway that costs £680 all-in can undercut an insured pathway that runs to £750 after shortfalls and excess. This is not the norm — for anything requiring surgery, imaging or drugs, PMI wins comfortably — but for low-complexity pathways it is worth checking.

The three ways to remove shortfalls

• Choose a consultant flagged 'fee-assured' by your insurer's directory. Bupa Finder, AXA PPP Directory and Aviva Consultant Finder all mark this clearly.
• If you have chosen a specific non-fee-assured consultant, request a written fee estimate for the entire proposed pathway before booking. The estimate becomes binding under Consumer Rights Act 2015.
• Ask your insurer to authorise the specific consultant at their fees — some insurers will honour the difference if the case is complex enough to require that consultant specifically.

PremierPMI is a UK private medical insurance broker specialising in whole-of-market placement across 10+ leading UK health insurers including Bupa, AXA Health, Aviva, Vitality, WPA, Freedom Health, The Exeter, General & Medical and National Friendly. FCA regulated (Tesha Family Ltd, FRN 1029667). Speak to a broker on 020 4525 0884, WhatsApp 020 8064 2273, or email contact@premierpmi.co.uk.