1. Ask your GP for a referral to a specialist if required
2. Find your policy number and your insurer's contact details
3. Contact your insurer's claims team or fill out a claim form online
4. Get treatment from a health professional
5. Y our insurer pays the bill for you directly
What you can claim for Health insurance can pay for medical treatment including:
Seeing a private GP
Diagnostic tests and consultations
Appointments with health specialists
Surgery and other treatment
Some medicines and equipment
Staying overnight or for longer in a private hospital
Each insurer has different rules on what they can pay out for and what treatments and conditions they exclude. Some also let you add cover for specific things like physiotherapy and dental treatment.
How to make a claim
Find the information you need Check your policy documents to find:
- Your insurer's contact details
- Your policy or membership number
- Note down the details you need to let your insurer know, such as:
- Your illness or symptoms and when it began
- If and when you spoke to your doctor
- What treatment your doctor has recommended
Start your claim You can book a medical appointment and start the process:
By phoning your insurer and asking them to refer you to a specialist.
Online, using your insurer's website. You need an online account set up, which lets you start a claim for some symptoms.
By visiting your GP, who can refer you to a specialist for treatment. Some insurers need an Open Referral letter from your GP, which describes what treatment you need.
If your GP refers you for treatment, you then need to contact your insurer by phone or online. You can check they can cover your treatment and start the claims process.
They will send you any paperwork you have to complete and ask you for all the details they need.
How long does it take?
Once your insurer agrees to cover your treatment, you can book the appointment immediately. You do not have to wait for payment first.
You can either:
-Ask them to book an appointment for you
- Book an appointment with a medical specialist yourself
Some insurers give you a pre-authorisation number if you book the appointment yourself. You need to give this to the private hospital, doctor or medical professional you use.
They should send the bill directly to your insurer, who will pay it for you.
Costs of claiming
Excess
Your insurer pays the bill for you directly to the treatment provider, but you may need to pay an excess. This amount is agreed when you take out your policy and is usually between £50 and £1,000.
You usually have to pay this amount directly to the treatment provider. For example, if your excess is £100 and you claim for a £300 appointment, you pay £100 to the medical facility and your insurer pays the other £200 to them.
Most policies only make you pay this excess once each year, so if you claimed for another £300 appointment that year, your insurer would pay the whole amount.
Higher premiums
Making a claim can make your premiums more expensive when you renew your policy it or take out a new one next year.
This is because when you take out health insurance, any symptoms or illnesses you have claimed for before are known as pre-existing conditions.
They can push up the cost of your premiums next year, and a policy from a new insurer could even exclude cover for pre-existing conditions.
What if your claim is rejected?
This can happen if your insurer decides your policy does not cover the treatment you requested.
If this happens, carefully check your policy documents to work out what your medical insurance covers.
If you think they should be able to pay for your treatment, ask them why they rejected your claim and complain if you think they are wrong.
If you need treatment for something your policy does not cover, you could:
- Pay for private treatment yourself
- Get treatment on the NHS instead
FAQ: How to Claim on Your Health Insurance
Q1: What documents do I need to submit a claim?
A1: Typically, you will need your insurance policy number, claim form, medical bills, receipts, and any relevant medical reports or discharge summaries.
Q2: How do I obtain a claim form?
A2: You can usually get a claim form from your insurance provider’s website or by contacting their customer service. Some insurers also provide forms through their mobile apps.
Q3: What is the process for submitting a claim?
A3: Fill out the claim form accurately and attach all necessary documents. Submit the form either online through the insurer’s portal, via email, or by mailing it to the claims department.
Q4: How long does it take to process a claim?
A4: Claim processing times vary by insurer but typically take anywhere from a few days to several weeks. You can check the status of your claim through the insurer’s customer service or online portal.
Q5: What should I do if my claim is denied?
A5: Review the denial letter for reasons and gather any additional documentation that may support your case. You can then appeal the decision by following the insurer’s appeal process.
Q6: Are there different types of claims I can submit?
A6: Yes, you can submit cashless claims (where the insurer pays the hospital directly) or reimbursement claims (where you pay the hospital and claim the amount back from the insurer).
Q7: Do I need to inform my insurer before seeking medical treatment?
A7: Yes, for certain treatments or hospitalizations, you may need to obtain prior authorization from your insurer. Check your policy for specific requirements.
Q8: Can I claim for pre-existing conditions?
A8: This depends on your policy. Some insurers have waiting periods for pre-existing conditions, while others may not cover them at all. Review your policy for details.
Q9: What if I have multiple insurance policies?
A9: You can claim from multiple insurers, but you should disclose all policies to each insurer. They may coordinate benefits to avoid overpayment.
Q10: Is there a time limit for submitting a claim?
A10: Yes, most insurers have a time limit (usually between 30 to 180 days) for submitting claims. Check your policy for the specific timeframe.
By understanding these FAQs, you can navigate the health insurance claim process more effectively!
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