What happens if I need to make a claim on my health insurance?

As soon as you receive a referral letter from your GP, you can speak to your insurer and depending on your cover levels, your claim will be assessed for eligibility. Once approved, you will receive an authorisation code to cover the cost of the investigation or treatment (subject to cover levels). You will not have to sit on a lengthy NHS waiting list for ongoing medical assessment or treatment. 

If your condition is diagnosed as chronic your insurer will cover the cost of the initial diagnosis and the cost involved in getting you back to a stable condition. Your insurer will not usually cover the ongoing monitoring of a chronic condition. However, they will usually cover flare ups of a chronic condition.

Step 1

Firstly, you will need to visit your GP and you will require a referral for a consultation with a specialist in most cases as the first step.

Step 2

Let your GP know you have private medical insurance and if you need to see a specialist, your GP will be able to provide you with a referral letter. The GP can either recommend a specialist privately or you can choose someone that has come recommended to you. If you want to choose your own make sure you ask your GP for an open referral, meaning you can see any specialist in that medical field. (provided they are covered by your insurer).

Step 3

Once you have a referral letter you can then contact your insurer. They will likely ask you for your policy number. If this is the first claim you have made against you plan be aware that it may take slightly longer than a normal claim as the insurer will need to get access to your medical records to assess the claims merit. This is usually done by you providing a GP referral and additional notes on the condition, such as when it started and what the presenting symptoms are.

Step 4

Your insurer will then be able to assess the claim and once approved you will be able to book the necessary treatment. This in practice should happen much sooner than an appointment would have been available under the NHS.

Step 5 

Following your treatment, the bill will go to your insurer for payment. They will settle the bill in line with your cover options.

Depending on your insurer and the options on your policy, you may have to pay an excess at the point of claim.