Your health insurance could pay if you need private medical treatment or even a private consultation or inpatient care. Understanding the steps involved with making a claim can ensure you receive the necessary medical care without unnecessary delays.
Around 8 million people (13%) have private medical insurance in the UK, and if you are one of them, you may be wondering how exactly to make a claim. This guide shows you the steps to make a claim, even if your desired treatment is not covered by your health insurance policy.
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How Do I Make a Claim on My Health Insurance Policy?
Step 1: Check Your Plan
Before making a claim, check whether your treatment is covered by your health insurance policy. Review your policy documents or contact your insurer to understand the scope of coverage and any limitations or fees that may apply.
Step 2: Contact Your Insurer
Contact your health insurance provider to notify them of your intention to make a claim and explain the treatment or medical service you require.
Step 3: Get a Referral if Needed
Depending on your policy, you may need a referral from your GP or specialist to proceed with the treatment. This can be because the treatment requires testing or a quick check, for example.
If a referral is necessary, contact your GP and ask them to provide the referral documentation to your insurer. Your insurer will tell you what to ask for.
Step 4: Submit Supporting Documents
Your insurer may ask for additional documentation to support your claim. This can include:
- Medical reports
- Test results
- Invoices
- Receipts
- Paperwork
Step 5: Wait for Approval
Once you have submitted all the necessary documents, your insurer will review your claim. They will check whether the treatment or service is covered by your policy and meets the specified criteria. At the end of the wait, your insurer will notify you of their decision, either granting or denying the claim.
Step 6: Get Treatment
If your claim is approved, you can proceed with the recommended treatment. Notify the healthcare provider to ensure they bill your insurance company directly. In some cases, you may need to pay upfront and then submit the receipt for reimbursement, depending on your policy terms.
What Should I Do if I Need Treatment Covered by My Health Insurance Policy?
Step 1: Consult Your GP
Start by scheduling an appointment with your GP to discuss your medical condition, symptoms, and treatment options. If your GP thinks that specialist care or further tests are needed, they will give you a referral letter explaining the required treatment.
Step 2: Contact Your Insurer
Contact your health insurance provider and inform them about your medical situation. Provide them with the referral letter from your GP explaining the recommended treatment and any further specialist consultations that might be needed. Your insurer will guide you through the claims process and provide further instructions.
Step 3: Get Authorised
Your insurer will assess your case and determine if the treatment is covered under your policy. They may request additional information such as medical reports or test results. Once the authorisation is granted, your insurer will provide you with a reference number, which you should keep for future reference.
Step 4: Schedule Your Treatment
With the necessary authorisation documents in hand, you can proceed to schedule your treatment. Communicate with the healthcare provider, ensuring they are aware of your insurance coverage.
They will work directly with your insurer to arrange billing and payment. Again, you may need to pay upfront and get reimbursed by your insurance company.
On the day of your treatment, present your authorisation reference number to the healthcare provider to make sure the process goes as smoothly as possible.
What Documents Do I Need to Submit When Making a Health Insurance Claim?
When making a health insurance claim, you will typically need to provide the following documents and information:
Claim Form
Most insurers require you to complete a claim form that includes details such as your personal information, policy number, treatment dates, and a description of the medical services received.
Medical Records
You may need to submit relevant medical records, including doctor’s notes, test results, diagnostic reports, and any other files you may be asked for before, during or after your treatment.
Invoices
If you are seeking reimbursement for out-of-pocket expenses, ensure you retain any invoices or receipts. This may include bills for consultations, medications, hospital stays, or treatments.
Referral Document
If your policy requires a referral from your GP or a specialist, you will need to provide the referral letter or relevant documentation as part of your claim.
