Private Health Insurance Consultant Fee Shortfalls Explained

A consultant-fee shortfall can arise when a specialist charges more than the amount your insurer has agreed to pay for an eligible service. Whether you pay the difference depends on your policy, the consultant’s fee arrangement and any insurer guarantee or fee limit.

Check before you agree to treatment

Ask the insurer what it will pay for the consultation, procedure and follow-up appointments. Ask the consultant for a written estimate that separates their fee from hospital, anaesthetist and other charges. Compare the estimate with the insurer’s authorisation and ask who is responsible for any gap.

Avoid unexpected bills

Use an approved consultant where required, and ask whether the provider has agreed to the insurer’s fee terms. A hospital package price may include several services, but confirm exactly what it covers and what could be billed separately.

Does pre-authorisation prevent a shortfall?

Not necessarily. Approval may apply only to specified services or amounts. Check the authorisation details and contact the insurer if the treatment plan changes.

For a fuller breakdown of private treatment costs, see our guide to consultant and hospital fees.

Sources checked 18 October 2026: PHIN: Self-funding treatment and fees · PHIN: Understanding consultant costs