How To Get A Claim On Your Health Insurance?

What is private health insurance?

Private health insurance plans in the UK allow you to pay for non-emergency, private medical care that you require to get fast-track access to treatments. As we know, some NHS procedures are subjected to long waiting times, but private healthcare can help you avoid this. In fact, sometimes, these policies let you pick the location, date, and hospital for your treatment. Also, if you require an overnight stay at a hospital, most UK policies provide coverage to a private and well-equipped room.

How Does Private Health Insurance Work?

Also known as private medical insurance (PMI), it covers private medical treatment, surgery, and tests if you’re injured or ill during the policy’s term. It is mainly designed for acute conditions such as curable and short-term.

You are normally required to pay a monthly amount to your health insurer, which is known as a premium. After that, when you want to get the treatment that your insurance policy covers, the overall expense during the treatment is paid by the insurer.

Health insurance is used to provide treatment alongside the service provided by the NHS. For example – Even though you can consult with the GP through the NHS, privates medical insurance in the UK offer numerous benefits:

• You can decide where you want to get the treatment
• Skip NHS waiting lists
• Get a private room
• Access to a wider range of treatment types

What does it cover?

Every health insurance is unique, and it depends on the insurer, but there are a few common things that most of the policy will include, they are:

• Inpatient care: You can stay in a hospital bed for your surgery and tests.
• Outpatient care: Get consultation treatment when you do not want to stay overnight.
• Day-patient care: It includes general appointments but not staying in a hospital overnight.

Other health insurance providers also give a choice to select what should be covered. The options include:

• Treatment for specific diseases like cancer
• Psychiatric treatment
• Physiotherapy
• Dental treatment
• Optical appointments
• Mental health treatments

Please remember that there are various health insurance options. The cheaper your policy, the fewer benefits it will cover. Comprehensive health insurance is quite expensive, but it provides ultimate benefits and the highest level of coverage. For better understanding, please consult with the best private health insurance broker in the UK at Premier PMI, and we will help you choose the best policy for you and your family.

How Do You Claim Private Health Insurance?

The health insurance claim process varies from one provider to another. For example, some companies may ask you to call or complete a claim form, or others will just let you complete the process through an app. Also, the claiming process might vary depending on the type of coverage you acquire. Thus, it is important to understand the process that goes well with your chosen policy. But, there are four general steps for claiming health insurance, they are:

Step 1: Visit your GP

If you do not have direct access to your private health insurance, the claiming of health insurance starts with speaking to a GP. This helps in ensuring that you’ve been rightly examined by a suitable treatment provider who offers the care you need. To submit to your health insurer, you must get an open reference letter from your general practitioner. This enables you to select a specialised healthcare provider from their list of possibilities. But, there are some virtual options available as well to get a reference and save you from the hassle of getting an appointment.

Direct access: There can be a certain situation where you may completely avoid the GP visit. Direct access appointments are provided by certain providers, like Bupa, for illnesses like cancer, mental health care, and musculoskeletal problems. Your insurers will give you information on how to schedule a provider appointment without first visiting your general practitioner.

Step 2: Begin your Claim

Once you have consulted a GP and got your open referral letter, it’s time to connect with your insurer to get a claim. You can do it online, through an app, or over the phone. You must share your policy number and a copy of your referral letter. If this is your first claim, be aware that it might take time. This is because the insurance company will review medical records to determine coverage. Remember, pre-existing conditions are not included in the cover.

Step 3: Contact with your policy provider

Whether you want to consult with a doctor or visit a nearby hospital with specific facilities, you can arrange private treatment with a chosen provider. Many insurance providers cover an extensive list of hospitals and consultants. But, it always comes with some limitations. Thus, it is advisable to do thorough research and connect with the best consultant or hospital. You can also examine lists online, as some insurance companies offer virtual assistance.

What are Guided Consultants?

A standard hospital list will be sent with your private health insurance so you can select the hospital of your choice. But, if you have specific references or consultants in mind, it could affect your overall decision to choose the hospital from the list given by the insurer. An expanded hospital list also comes with a higher price. These usually include more expensive treatment providers, frequently because they live in a metropolis where rent, utilities, and wages are all higher.

On the other hand, when you choose a guided consultant choice, your insurance company will provide you with a list of private hospitals and consultants. They also ensure that the list only has the recommended consultants who can treat your illness and are specialists in that particular area.

Step 4: Pay the Bill

After getting your treatments, the hospital will provide you with an invoice(sometimes directly to the insurer). You are required to pay the excess amount itself if there is an excess on your policy. When an insurance company pays a bill, they usually get in touch with you to arrange payment, but when you first file a claim, they should inform you of the amount you will be responsible for.

How to claim with the UK’s leading health insurance providers?

Aviva Health

Aviva’s claiming process is easy. Follow the given below procedure to claim the insurance:  

• First, visit your GP or schedule an online appointment. Ask for an open referral so that Aviva health insurance can help you find the best medical facility and consultants covered by your policy. 
• The next step is to make a claim. Aviva suggests you claim online through the MyAviva portal, although you also have an option of calling them. After a meeting, you will be asked to share your symptoms, like when they started and for what treatment you’ve been referred for. If they approve your claim, you will get the private treatment you need. 
• Finally, once you have had the treatment you need, Aviva will settle the bills with your provider.

TheExeter

The process of claiming The Exeter Insurance depends on your coverage type. 

Claim Process: Firstly, you are required to consult your GP and get an open referral. There are two health insurance plans (Standard vs. Guided Cover) offered by The Exeter.

Claiming Process for Standard Cover

• Consult with your GP and get a referral for a specialist. You can choose your own specialist, but ensure they’re on your hospital list.
• Start your claim by calling Exeter.
• After your initial appointment, Exeter will contact your specialist to confirm treatment details and coverage. 
• Finally, after the treatment, Exeter will pay the amount directly to your specialist. If there is an excess, that difference is paid by you.

Guided Cover:

• Visit Your GP and get a referral for a specialist.
• You can choose your specialist. You will get a list of up to three specialists from which you can choose.
• Exeter will select a convenient hospital for your treatment.
• Finally, the payment will be made.

Bupa

Bupa – one of the largest health insurance providers, provides direct access to treatment to patients with various issues, including cancer symptoms, mental health issues, and musculoskeletal conditions. In this way, customers are not required to get a GP referral, and they can get an appointment with a consultant directly. But, there can be circumstances where you are required to see a GP for an examination to confirm your treatment and request an open referral. For this, you can either use Bupa’s digital GP service or book an appointment. 

You need to call Bupa and explain your symptoms, including everything, such as what private medical treatment the GP has recommended. After that, you will get a form to complete, and when they get a confirmation that you’re covered, you will be assigned a pre-authorisation number. If you want, you can also get two or three consultant recommendations from Bupa, and you can choose from them depending on your requirements. Also, you can look for other consultants and hospitals through their online directory.

Vitality Health

Vitality is another popular insurance company that brings multiple services via the Member app and Member Zone, including direct access to physiotherapists, menopause, and mental health support. The claiming process for Vitality includes the following:

• Get a Referral:  Vitality also asks for a GP referral. You can consult with a GP to book an appointment through the Vitality GP or by using the telephone service.
• Start your Claim: Once you get a referral, it’s time to start a claim online and make sure to examine if your treatment is covered by your plan. 
• Book Your Treatment: For the treatments, you can choose the specialists from the given approved list of Vitality.

Note: For some health conditions, you can get medical treatments without making an appointment to visit a GP first. But please note that in some circumstances, an excess may apply.

Freedom Health

Freedom Health Insurance offers two different types of policies: Freedom Elite and Freedom Essentials. The claiming process of both policies begins with seeing your GP and giving a call to Freedom for a pre-authorisation code.

A Freedom Elite health insurance claiming process is simple, with no requirement to fill out a claim form. You can choose your own hospital where you want to get treated, and after this, Freedom Health Insurance will pay the bill directly to the healthcare provider. In other cases, if you choose the NHS, Freedom gives you the cash benefit after you’ve been discharged.

On the other hand, if you are a Freedom Essentials policyholder and you’re looking for inpatient or outpatient treatment, you can claim a fixed cash benefit that will be directly paid to you. You are required to call the Freedom Claims helpline to confirm whether the claim will be covered by your policy or not before undergoing treatments.

WPA

The claiming process for WPA health insurance starts with consulting your GP, or you can use the Remote GP services benefit to get access to a remote GP helpline. 

Once you have a referral, you can start your claim in the WPA health app or via the MY WPA section of the website. When the claim process is set up, you’re required to share details of your symptoms and other information about the hospital provider that you have been referred to, including your name and address.

The WPA also lets you know which healthcare providers your policy covers and gives you an immediate pre-authorisation code to allow you to get the treatment. 

After getting the treatments, the company will pay the bills for your treatments and tests directly to the healthcare provider.

How Can We Help?

The overall process of claiming health insurance is a crucial part of your experience. Indeed, your preferences can affect your choice of health insurance provider. If you are looking to get a private health insurance comparison in the UK, trust the team at Premier PMI. Whether you’re seeking family health insurance or corporate insurance, we have got you covered. We will also help you compare different insurance policies based on your requirements and choose the best one for you. For us, your health matters, and we want you to be protected no matter what.

Stuart Hendy, Senior PMI Advisor &Editor

Stuart Hendy is a highly experienced health insurance broker with extensive knowledge of private medical insurance and private treatment. His expertise is frequently sought by industry professionals and his insights have been featured in leading financial publications. Stuart is committed to providing his clients with the best possible healthcare solutions and empowering them to make informed decisions.

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