How to make a claim on your private health Insurance

Preparation

The key to any insurance claim is to be prepared at all times to make one. This means keeping an accurate record of all receipts and making sure that your policy documents are to hand should you need them. 

What is excluded?

When you find yourself ill, or injured, it’s important to make sure you know your policy before you seek out private medical care. Private insurance is designed to cover acute conditions, a short-term illness or a broken bone. So, before you seek care outside of the NHS, make sure you are covered as it can quickly become very expensive, or a private hospital might simply be unable to treat you and waste valuable time. 

Typical things that you can claim back on your policy

Obviously no two policies are the same, so you could make a claim on one that would not be possible on another (check the terms and conditions or speak to your insurer to find out exactly what is covered). However, there are a few key treatments that most policies will include: 

• Some surgeries and other treatments 
• Some medicines 
• Seeing a private GP 
• Receiving a diagnostic test 
• Staying overnight or longer 
• Health specialist appointments 

The steps to making a private health insurance claim

When making a private health insurance claim there are a few general steps that you should follow: 

Step 1: Seeing your GP / Contacting Insurer 

There are two ways you can begin your claim: 

1. Some insurers will need you to go to the GP first. This is so you can get a referral letter. This will either be for a specific consultant or it could be open. When it’s open, your GP will simply set out the treatment they believe you need. You will then need to speak to your insurer to get a pre-approved claim. This is key because you will not be covered unless your claim is pre-approved. 
2. If you already know your diagnosis, and your insurer doesn’t require you to see a GP, you can also contact your insurer and ask them to refer you to a specialist. This can either be done online or over the phone. 

Step 2: Booking an Appointment 

Once your claim is pre-approved, you will then have to book an appointment. Some insurers will actually do this for you, whilst others will require you to arrange it yourself. If you have to book it yourself, they will give you a pre-authorisation number which you will need to take to the private doctor or hospital you are seeing. 

Step 3: Paying the Bill 

In most cases, after receiving the treatment, the insurer will then pay the bill for you. This bill will be minus the pre-approved excess that you agreed when you took out the policy. 

What is voluntary excess?

Excess is the amount you agree to pay when you take out your insurance policy in the event of a claim. So, if your bill is £1,000 and your voluntary excess is £100, you will pay £100 direct to the hospital or doctor and the insurance company will pay the rest. The higher the excess, the lower your premiums will be. Usually, there is only one excess per year, meaning that if you then have another appointment approved in that same year, the insurance company will pay it in full and you will not have to pay any excess. 

Moratorium delays

In general, health insurance companies are reluctant to cover you for pre-existing conditions. What this means in practice is that your policy will not cover you for health issues that you have had in the last 5 years. If this is the case, then the insurance company will take more time to approve your claim to go over your medical records.