Making a Claim

If you have health insurance the private treatments you can claim for depends on the type of cover you have. Each health insurer has their own claims process, which is normally explained in the small print of their policies or on their websites. We are lucky enough to have the NHS in the UK – which provides free health services and treatments when we need them. If you have private medical insurance, you can choose to receive treatment via the NHS or at private centres or hospitals.

Private Referrals

Most private health insurance claims start with a GP referral. If you have a new illness or condition that is concerning you, make an appointment to speak to your GP. When at your appointment let your GP know you have health insurance, they can then help you put together a referral which allows you speak to your health insurance provider about accessing private services.

There are two types of referrals:

Open referral

An open referral is not addressed to a named consultant or specialist.

Listed referral

A listed referral is addressed to a named consultant or specialist.

If you have either of the above referrals you can speak to your health insurance provider about the next steps you need to take to access private treatment.

Paying for Private Treatments

After agreeing on the private treatment, your provider will then confirm how payment will be made. In your health insurance policy, it will state whether your provider pays for the treatment directly or whether you must pay for the treatment first, and then claim the money back from your insurer.

If you have private health insurance, you may be required to pay an excess if the insurance provider pays for the treatment directly. An excess payment amount is agreed when you take out your policy and can range between £50 to £1,000.

The agreed excess amount is paid to the insurance provider by the policy holder. Sometimes, policyholders pay a ‘once a year’ excess to their insurer. If this is the case, the policy holder normally only pays this amount once – even if more than one treatment is required.

Rejected private health insurance claims

If your request for treatment is rejected this is most likely because your policy does not cover the treatment. If this is the case, check your policy details to understand why the treatment was not covered and the claim was not approved.

If your claim is rejected, you can seek treatment via the NHS or opt to pay for the treatment yourself.

Increase in premiums

If you make a health insurance claim, the cost of your premiums when you renew will likely increase. This is because the treatment you have received may be for a condition which then becomes a ‘pre-existing’ condition.

If you have any questions or would like to discuss your health insurance cover – fill in our online form for free and impartial advice.