How to claim on your health insurance

When it comes to making a health insurance claim, the process is straightforward but there certain things you need to do in order to ensure everything goes smoothly and the plan pays out as expect.

The health insurance claim process may vary slightly from company to company but there is typically an order by which you need to do things.

Step 1 – Visit your GP

Visit your GP so you can be referred for further consultation, tests or treatment. Some health insurers offer their own virtual GP service that you can speak to in order to be referred as opposed to arranging an appointment with your local GP.

It’s worth mentioning that not all health claims have to be referred through your doctor as some treatments can be accessed immediately, so read your policy documents before proceeding.

Step 2 – Get referred

Get an ‘Open Referral Letter’ from your GP which details the medical treatment you need. Alternatively your GP may give you the name of a specialist they recommend and wish to refer you to.

Step 3 – Start your medical claim

Contact your medical insurance claim department by phone or by using their online health claims process. They will require either the details from your Open Referral Letter or the name of the specialist your GP has recommended and where they practise, as they will need to confirm that they are registered with them.

In addition, your insurance provider’s health claims department will also need:

  • Your private medical insurance policy number
  • Information on your condition and when it began
  • The treatment your doctor has recommended     

Step 4 – Arrange treatment

Once your health insurance claim has been agreed, your private healthcare provider will either book the appointment for you, or you can book it yourself. If you make the arrangements yourself, your insurer may provide you with an authorisation code that you should give the private hospital /consultant when you attend the appointment.

Step 5 – Keep the health claims team updated

If further medical treatment is required once you have attended your appointment such as an operation, you should contact your private medical insurance provider again with details of what is required and when it is scheduled to take place.

Also you should have been given a procedure code called a CCSD code which your healthcare provider will need to add to your medical claim details.

Step 6 – Pay the bill

The bill for your medical claim should go directly to your private health insurance provider for them to make payment. If it is sent to you, just pass it on to your insurance company.

If however there is excess to pay, you will be billed directly for your share of the payment. Any excess on your medical insurance would have been agreed when you first arranged your cover; usually between £50 to £1,000 and will be detailed in your healthcare documentation.

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