Making a Claim
If you feel unwell, or consider that you require medical treatment for a particular complaint, you will first need to visit your GP. Your GP will determine whether the problem merits specialist investigation or treatment. Many private health insurers will accept claims only when you have been referred to a specialist; GP diagnoses and NHS prescriptions are not covered by the majority of policies, see Exclusions. You may wish to ask your doctor to refer you to a specialist who is willing to do private medicine, if possible.
Once you have been referred, you will need to contact your insurance provider to ask whether or not your treatment entitles you to make a claim. In order to determine this your insurer will usually need to know the specialist's or hospital's name, the date of your appointment or admission, and any other important details of the claim, such as your insurance number or a medical procedure code.
If your treatment or test is covered by the policy, your insurance provider will send you a claims form, which you will need to fill out and return. You may be required to take the claims form with you when you visit the specialist, so that they can fill in certain details before returning the form to your insurer. Your insurer should refund you for the cost of eligible tests and treatments.
If you need further tests or treatment, you will need to contact your insurance provider again. Essentially, you need to inform your insurer every time you go for tests or treatment which could result in a claim. This ensures that you are consistently advised as to whether the treatment you are receiving is covered by your private insurance, and ensures that your insurer is able to check the details you give them and process your claim.
The exact procedure for claiming from your insurer may differ from this general model. Your insurance provider should describe their claims procedure in detail in your policy booklet: this is sent to you when you purchase the insurance, and typically tells you exactly what you need to know. There will usually be a claims hotline listed which you can call when you wish to speak with an advisor.
