How to claim on your health insurance

You've invested in health insurance, and now you need to claim to access private medical treatment. How do you claim, and what can you expect from the process? Here's our guide to claiming on your health insurance.

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This article was written by:
Chris Steele
Founder and Editor

Chris is our resident private health insurance and healthcare expert. He has over a decade of experience writing about private medical insurance and treatment. He's Chartered Insurance Institute qualified and is regularly quoted by the national press.

How health insurance works

Private health insurance covers private medical treatment so you can access care quickly and easily. Your health insurance policy provides core coverage for things like inpatient treatment and cancer care. Depending on your needs and budget, you can add optional extras, such as outpatient cover. You're covered as soon as you start paying your premiums.

When you take out the policy, your health insurance provider will provide details of their claims process.

The claims process

The claims process will vary depending on your insurance provider and the tools they have in place. Some will ask you to call or complete a claim form, while others let you make a claim online or via an app.

The process may also depend on the type of coverage you have. For example, some insurers offer cash plans that give you cashback when you receive treatment with the NHS or another treatment provider, such as your dentist or optician.

It's important to check the process that applies to your chosen policy.

The 4 steps to claiming on your health insurance

While there may be some variations depending on your chosen health insurance provider, most claims follow the same basic format. Here are the steps you can expect to follow.

1. Visit your GP

Unless you have a direct access option with your private health insurance (more on that below), you'll need to speak to a GP before you start your health insurance claim. This ensures that you've been appropriately assessed and referred to a suitable treatment provider who offers the care you need.

You'll need to ask your GP for an open referral letter to take to your health insurer. This allows you to choose a specialist healthcare provider from their list of options.

You can ask for an open referral from your NHS GP. However, if you find it difficult to get an appointment, you can also get a referral from a virtual GP service. All health insurance companies offer digital or virtual GP appointments where you can be seen online at a time to suit you.

Direct access

In some circumstances, you may be able to skip the GP appointment altogether. Some providers, such as Bupa, offer direct access appointments for some conditions, including cancer, mental health support and musculoskeletal issues.

Your insurers will give you details about how to book an appointment with a provider without having to see your GP first.

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2. Start your claim

After you've seen your GP and received your open referral letter, contact your insurer to make a claim. This could be via an app, online or by phone. You'll need to give them your policy number and a copy of your referral letter.

Your insurance company will check to ensure your policy covers the treatment. Depending on the underwriting your policy has, they may also check your medical history. Pre-existing conditions are excluded from cover. If you need private healthcare to treat a problem with your shoulder but saw your GP about shoulder pain just before you took out the policy, your care won't be covered.

Pre-authorisation

If everything's OK with your coverage, your insurer will give you a pre-authorisation number to use with your chosen treatment provider.

3. Find healthcare providers

You can arrange private treatment with a provider you choose as long as your policy covers them. You might want to see a specific consultant or go to a hospital close to home or with particular facilities.

Many providers cover an extensive list of consultants and hospitals. However, there are usually some restrictions. You may want to do your research to help you choose a consultant or hospital. Some insurers have a searchable list online so you can check what's available in your area when you need care or before you take out a policy.

Your insurance company should be able to provide you with information and guidance to help you decide, or your policy may limit your choice to help you save money.

Hospital lists

Your private health insurance will come with a standard hospital list so you can choose your preferred hospital. If you have a particular consultant in mind, this may influence your choice.

However, you can also pay more for an extended hospital list. These typically include treatment providers whose costs are higher, often because they're in a city where wages, rent and utilities all cost more. There is often also an option to choose an extended list which includes Central London, as private healthcare costs are highest there.

Guided consultants

guided consultants list can be a good way to save money on your health insurance. These lists include high-quality hospitals and experienced consultants who have agreed to keep their costs below a specified level. If you've chosen this option, your insurance company will give you a shortlist of 3-5 consultants or hospitals to choose from when you claim.

4. Paying the bill

After your treatment, the hospital will invoice your insurer directly in most cases.

You'll need to pay the excess amount yourself if there's an excess on your policy. Insurers typically contact you to arrange payment when they pay the bill, but they should let you know how much you'll need to pay when you first make a claim.

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How to claim with the UK's leading health insurance providers

While the health insurance claims process is broadly similar across the board, individual providers vary. Your circumstances may influence how you'd prefer to claim on your health insurance. You might want an insurance company that lets you speak to a person over the phone. If you have a busy life, a health insurance app or online claim form allows you to claim at a convenient time, even if the call centres are closed.

Here's our round-up of the claims process with the leading health insurance companies in the UK.

How to claim with Bupa

Bupa is one of the UK's largest health insurers and offers direct access treatment to patients with cancer symptoms, musculoskeletal conditions and mental health issues. Customers with access to this service can get an appointment with a consultant without needing a GP referral.

Otherwise, you'll need to see a GP for an assessment to confirm your treatment and request an open referral. You can book an appointment with your NHS GP or use Bupa's digital GP service.

You'll then need to call Bupa. They'll ask for details of your symptoms, what private medical treatment the GP has recommended and send you any forms you need to complete. When they've checked that you're covered, they'll provide a pre-authorisation number. They'll also recommend two or three consultants for you to choose from. You can search for consultants and hospitals using their online directory.

You can learn more about how to claim with Bupa on their website.

How to claim with Aviva

Aviva's claims process starts with a visit to your GP (or an appointment via their digital GP app). They'll accept named referrals to a specific consultant. However, they reserve the right to offer you other options. Generally speaking, it's a good idea to request an open referral, but it may also be your only option if you have one of their guided consultant lists.

If your employer provides your health insurance, check whether your cover includes BacktoBetter or Aviva's mental health pathway, Aviva's direct access service for musculoskeletal and mental health issues, as these allow you to skip the GP referral.

Aviva recommends starting your claim online through the MyAviva portal, although you can also call them. They'll ask for details about your symptoms and will endeavour to make an immediate decision on your claim, although they may need to investigate further in some circumstances. They'll let you know what tests and treatments are pre-approved.

You can choose your hospital or consultant from your hospital list, or they'll recommend specialists if you have a guided consultant choice. You'll need to update them using MyAviva, on the telephone, or using their Live Chat service if your consultant recommends further treatments. They'll also pay your bills direct and contact you via MyAviva if you need to pay any part of the invoice.

Find out more about the process here.

How to claim with Vitality

Vitality offers various services via its online Member Zone and Member app, including direct access to physiotherapists, mental health practitioners and menopause support. If you want to see a consultant, you'll need a GP referral. You can see your NHS GP or book a GP appointment via the Vitality GP or using their telephone service.

You can also book a call with one of their specialist support teams for various conditions, including mental health issues, musculoskeletal disorders or cancer.

Aviva will give you an immediate decision if they can or schedule a call if they need further information. They'll provide you with a care reference number, which allows your consultant to send the bills straight to Aviva. If your consultant recommends hospital treatment after your first appointment, you must update them online.

They'll pay your consultant's invoices and email you if you need to pay an excess. Find out more about Vitality's claims process on their website.

How to claim with The Exeter

The claim process with The Exeter varies depending on your cover. You'll need to see your GP for a referral. If you have their standard cover, your GP can recommend a specialist, or you can do your research to choose one; you'll need to check your hospital list to make sure the consultant you choose is covered. You'll need to start your claim by telephone, and your health insurers will ask for a copy of the referral letter. They'll also contact your consultant after your initial appointment to ask for details of any further treatments before confirming what's covered and whether the treatment can go ahead. They'll also pay your consultant direct, subject to any cover limits and excess amount.

The process is the same with their guided cover, save that they'll give you a list of up to three specialists to choose from and will make your hospital choice for any further treatment. You can find out more on their website.

How to claim with Axa Health

Axa Health insurance doesn't typically cover primary care, so you'll need to see your own GP to request an open referral before you can start your claim. You can, however, access advice from a physiotherapist for muscle and joint pain via their 'Working Body' service.

The next step in the claims process is to give Axa a call or register your claim online so that they can check whether your treatment is covered and choose a specialist via their fast-track appointments service. If your GP has recommended a specialist, they'll also check that they're covered.

After your appointment, you'll need to contact Axa to provide details of any recommended tests or treatments so they can authorise your claim. After your treatment, they'll pay your consultant or hospital and let you know how to pay any excess.

How to claim with WPA

After you've seen your GP or used WPA's remote GP service for a referral, you can start your claim on the phone, online or using WPA's app. Your GP can recommend a consultant, or WPA can let you know which healthcare providers your policy covers. Their website states that they'll give you an immediate decision and pre-authorisation code to allow you to book your care.

They'll let you know whether you need to pay towards your care but will otherwise settle the bills directly.

How to claim with Freedom

Freedom health insurance offers two different policies, Freedom Elite and Freedom Essentials. The claims process for both starts with a visit to your GP and a call to Freedom for a pre-authorisation code.

With Freedom Elite, you can book your appointments and update Freedom if you need additional treatment. They'll also pay your treatment provider direct, subject to your excess and health insurance cover limits.

Freedom Essentials customers must also call the helpline for approval but can choose from NHS care, private healthcare in the UK or private treatment overseas. This policy pays a fixed cash benefit, and the documentation you must provide varies depending on your chosen treatment.

Compare health insurance with myTribe

The process when you make a health insurance claim can be a crucial part of your customer experience, and your preferences may influence your choice of health insurance provider.

Contact us for a comparison quote, and we'll connect you with high-quality specialist brokers who can guide you through your options and help you find the right health insurance for your needs.

Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.

Frequently Asked Questions

Do I need to see my NHS GP to start a health insurance claim?

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Not necessarily. Most insurers have an online or virtual GP service that can give you a referral letter.

How can I contact my health insurer to start a claim?

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There are several different methods. You may be able to log into an online account or use an app to request private healthcare. Alternatively, some insurers prefer you to call them to start your claim.

Will I need to pay anything for my treatment?

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You'll need to pay if there's an excess on your policy. Your insurers should contact you to let you know how much you'll need to pay and whether there is any shortfall in the coverage your health insurance provides.

Can I get treatment without a GP referral?

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If your insurer provides a direct access service, you may be able to access physiotherapy, cancer support or mental health treatment without a GP referral.

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