Investing in Health: How to Avoid Overpaying for Medical Services Abroad

Private Medical Insurance

PMI (local private medical insurance) vs IPMI (international private medical insurance) vs public healthcare. What the difference means in practice and why it matters.

Private healthcare has become a familiar part of many people’s day-to-day infrastructure: it saves time, provides access to private specialists, and raises the standard of service. But this is precisely where expectations and reality most often diverge: the policy has been purchased, the monthly premium is paid on time, yet the moment a quick decision is needed, it turns out that insurance works quite differently from what was imagined.

These are the very questions we discussed with Kirill Alba, Director of Albatross Healthcare, a UK-based insurance brokerage specializing in private medical insurance policies for clients with a global lifestyle, as well as those simply seeking a more comfortable private healthcare experience.

From this interview, you will learn:

• how to choose a policy based on your lifestyle and residencies;
• whether it is possible to obtain coverage if pre-existing conditions are already present;
• how local (PMI) and international (IPMI) policies differ;
• the most common mistakes clients make;
• why the broker does not charge clients a fee.

Question: Why does the topic of medical insurance matter?

Kirill: For many people, the cost of treatment is usually not the primary risk (although it can easily exceed £100,000 or even £200,000). The real risk is the loss of time, control, and predictability in a situation where the stakes are higher than money: health, family, and the ability to continue living and working without disruption. So when someone begins thinking about this type of insurance, the right questions to ask are not “how much does a policy cost?” but rather “what specific problem will it solve?”:

• Does it speed up access to diagnostics and treatment?
• Does it offer a choice of doctors and hospitals?
• Does it allow treatment in the country I need?
• How are approvals and payments structured?
• Do I need psychiatric cover or private maternity?
• What happens in a non-standard scenario (business travel, multiple residencies, a complex family structure, visa requirements across different parts of the world)?

Only after answering these questions does it make sense to move forward.

Public and Private Healthcare: How It Works in the UK and Beyond

Question: What is the fundamental difference between private and public healthcare? Could you give an example of how it works in the UK and beyond?

Kirill: The public healthcare system in England is called the NHS. Its underlying principles are, in fact, not that different from those of any other European country where access is determined by clinical urgency and protocols. Being free for the majority of the population, it often suffers in terms of speed and quality of service. Cases where the waiting time for elective treatment exceeds a year are far from rare, and the standard benchmark within the NHS is, for instance, an 18-week wait.

The private sector, while closely linked to the NHS (and its equivalents across Europe), is nonetheless a separate infrastructure — private GPs, specialists, diagnostics, and private hospitals — where in most cases you are paying for speed, comfort, a managed patient journey, and access to medications that the public healthcare system is often unable to prescribe due to their high cost. Take Herceptin, for example — a drug used in the treatment of breast cancer. A course of this medication costs on average around £2,000–£4,000 per month, and while obtaining it through the public system is theoretically possible, in reality the stars need to align (and even then, only in small doses) for it to be prescribed. In private healthcare, it is prescribed in virtually every eligible case.

But there is a significant caveat. The key point about insurance is this: a policy is not a “subscription to absolutely any treatment on demand.” Both local and international policies, in the vast majority of cases, will not cover emergency treatment, and whether we like it or not, for emergency care we can only turn to public institutions. The issue here is not a reluctance to cover such treatment, but rather the simple absence of private hospitals capable of providing the full spectrum of emergency services — from a bruised finger to urgent surgery for a stroke or heart attack.

Question: You mentioned that there are two options: a local and an international policy. What are the main differences?

Kirill: Yes, fundamentally both cover treatment in private hospitals, but these insurance products work in entirely different ways.

1. Local policy — PMI, or Private Medical Insurance

This product operates in conjunction with the public healthcare system and is designed exclusively for treatment within a specific country. The moment you board a plane, your policy stays behind. Treatment under these policies can often only be obtained at specific hospital networks with which the insurer has contracts, and all conditions must be met precisely in order to access care — for example, obtaining a referral from a public GP and securing pre-authorisations before any treatment begins. It is generally inexpensive and does genuinely help obtain treatment faster than through the public system, but due to bureaucratic complexities and a number of significant restrictions, it proves in practice to be a very difficult product to use.

2. International Private Medical Insurance — IPMI

As the name suggests, if you board a plane, the policy flies with you. But in reality, it is designed not only for people who value the geographic scope of their coverage — or, in other words, the ability to receive treatment from the best specialists in the world, regardless of where they are located — but above all for the flexibility of that treatment. This means the ability to use private GPs (rather than public ones), the freedom to choose any hospital or specialist without network restrictions (and, more broadly, the ability to see the right specialist without any referral), and access to the kind of responsive customer service that Russian-speaking clients, in particular, tend to expect.

What PMI and IPMI Policies Actually Cover

Question: So what exactly do these policies cover?

Kirill: At the core of both PMI and IPMI lies almost always the same logic: the basic “skeleton” of coverage is built around private inpatient care, comprehensive cancer cover and, depending on the plan, an outpatient treatment module, as well as optional upgrades (dental, mental health, maternity, etc.).

Inpatient typically includes hospitalisation, surgery and associated in-hospital expenses, inpatient treatment, and diagnostics carried out as part of the hospital stay. For many families, this block is the foundation: it covers the most financially significant and logistically complex scenarios.

Cancer cover is also a key element of such a policy. All insurers have carved out cancer treatment as a separate block, because in practice oncological treatment involves both inpatient stages and extended outpatient courses. What exactly is included always depends on the specific policy wording: typically it covers diagnostics, surgery, chemotherapy, radiotherapy, and related costs, but the details around advanced medications, supportive therapy, and course duration can vary. This is precisely why “cancer cover included” as a phrase means nothing without checking the actual Policy Wording — a document that clients all too often fail to read, yet it is exactly where all the terms and conditions are set out.

Outpatient refers to treatment without hospitalisation: specialist consultations, blood tests, MRI/CT scans, endoscopy and other diagnostics, day-patient procedures, and certain ongoing courses of treatment. In UK-based PMI policies, outpatient coverage is often subject to limits or offered as a separate option, whereas IPMI more commonly takes a modular approach, allowing clients to select a level of outpatient coverage suited to their family’s lifestyle. When comparing policies, it is therefore important to look beyond the word “outpatient” and into the specifics: limits, the list of covered services, approval requirements, payment rules, and what falls under which category.

As an example, with the insurer Cigna, MRI, CT, and PET scans happen to fall under inpatient limits, whereas with virtually every other insurer they are classified as standard outpatient. So if a client decides to reduce the premium by adding, say, a £1,000 excess (a deductible — the portion of treatment costs borne by the client) to inpatient, thinking it only applies to surgery, an unpleasant surprise awaits. As the saying goes, the devil is in the detail — and that definition most certainly applies to insurance policies too.

It is also important to understand that many things clients instinctively consider “part of healthcare” are often classified in insurance terms as optional extras. The most common options are mental health, dental, and maternity. Psychological and psychiatric care frequently carry separate limits and strict access rules. Dental is almost always limited and more often covers basic procedures, while complex work may be subject to low limits or exclusions. Maternity is most often not included in the standard base, requires a separate extension, and as a rule comes with a waiting period (18 months for many insurers) and limits — making forward planning especially important here.

Common Client Mistakes When Using Medical Insurance

Question: What typical mistakes do clients make?

Kirill: Look, people are different and so are their mistakes, but I would probably highlight a few telling examples:

1. Standard exclusions

The list is roughly the same across all insurers, but unfortunately there are still people who believe that absolutely every medical issue can be resolved through this policy. Sometimes it borders on the absurd. I had a young couple who purchased a policy. About 3–4 months later, the girlfriend called me and said: “Kirill, my boyfriend’s birthday is coming up, and since we now have a policy, I’d like to do something nice for him and get a breast augmentation. How do I go about it through the policy?” The short answer is: you don’t — cosmetic surgery is not covered unless it is medically necessary. That is, if part of a breast has been removed due to cancer and reconstruction is required, insurers will cover it in virtually every case, but elective cosmetic procedures — absolutely not.

2. “I know best”

A major advantage of international policies is the ability to go directly to a specialist without going through a private GP. Nevertheless, I still recommend to all our clients that they begin by seeing one, because a GP can not only recommend a good specialist for your particular problem, but also help determine what the problem actually is. Here is another recent example: the Head of Claims at one of the insurers called me and asked me to explain the client’s logic (the client herself was unreachable). The problem was abdominal pain. Which doctor did she see? You won’t believe it — a chiropractor. Why? Unclear. When we finally reached the client, the conversation went roughly like this:

• “Kirill, you’re supposedly in the industry, and yet you don’t understand the obvious. I had a pinched nerve in my neck, and I can feel the pain radiating down to my stomach, so I went to a chiropractor. What’s so hard to understand?”

I can, of course, imagine such a scenario, but with abdominal pain, the conventional route would be to start at least with a gastroenterologist (and looking ahead, that is exactly what the insurer ultimately covered — but due to the self-diagnosis, the chiropractor visit was declined, as the problem turned out to be with the stomach).

3. How symptoms are described

As I mentioned, conditions that existed before the policy was purchased are usually not covered. So when people see a doctor, they need to keep this in mind and at least briefly put themselves in the shoes of the insurer. Example — back pain. The conversation with the doctor:

• “Doctor, my back is bothering me.”
• “How long has this been going on?”
• “Oh, probably about 10 years. It used to only happen when I lifted heavy things, but it would go away, and now it’s flared up again and it’s much worse and a bit lower than usual, so I came to see you.”

A private doctor is, first and foremost, a doctor, and has little concern for whether or not the insurer will cover it. So in all likelihood, the clinical notes will read: “Symptoms began 10 years ago, ongoing to date, referring patient for...”

What will the insurer say? “Well, since symptoms were present prior to the policy, this is not an insurable event — declined.” And then the “song and dance” begins — attempts to prove that this is in fact a new symptom and a new health issue (which takes a great deal of time and resources). So be sure to read the doctor’s clinical notes (ideally while still in the consulting room) and, if you suspect the insurer may raise questions, it is best to ask for them to be reworded then and there.

4. And finally — pre-existing conditions

In the vast majority of cases, policies cover all new conditions that arise AFTER the policy is purchased (from day one, in fact), but anything that existed before will be subject to scrutiny. Regardless of the underwriting option chosen — whether FMU or Moratorium — the approach may differ slightly, but pre-existing conditions will not be covered for a minimum of two years.

Unfortunately, people very often think about buying such a policy only when a health problem already exists, it is very serious, and they decide to quickly purchase a policy in order to receive private treatment. Insurers are neither naive nor charitable organisations, so in such a situation they will not cover anything. And if anyone tells you otherwise — run from such advisors. We will, of course, advise on where and how to seek help with minimal financial loss, but purchasing a policy at that point will be a waste of money. It is something to think about while the “heavy medical baggage” has not yet accumulated.

Question: And one final question, perhaps — what role does the broker play in all of this?

Kirill: The question “why use a broker when I can buy online?” naturally occurs to people when purchasing this type of policy. But let me share a small secret: the price of the policy will be identical regardless of where you buy it — directly from the insurer, through aggregators, or from a broker like us. In practice, a good broker performs several key functions:

• selecting the right product to match the lifestyle and needs of a specific family;
• explaining complex insurance coverage nuances in plain language (without the help of ChatGPT, which for some reason still produces a great deal of inaccurate information on medical insurance matters);
• managing approvals and communication with the insurer in complex cases, and providing support in disputes and claim denials, where precise wording, documentation, and the correct sequence of actions are critical.

Not all brokers are willing to delve into the insurance weeds and fight for every client, but there is nothing stopping you from switching brokers every year if you are dissatisfied. Business is business. This is precisely why we are often approached not only by first-time buyers, but also by those who have held a policy for years and have never had anyone properly explain how the whole system works.