Health insurance provides peace of mind that your health is protected and in an ideal world, you won't need to make a claim.
However, if the time comes that you do, you’ll want full confidence that you know what to expect and how the claim process works.
Whilst the claims process can vary depending on your insurance provider, they are generally quite similar. Here's everything you need to know about health insurance claims.
Health insurance claims involve claiming on your insurance policy when you need treatment for a health condition or concern.
When you make a claim your insurance provider will cover the bills (excluding any excess you've agreed to) when you have treatment at a private facility, provided it’s covered on your policy.
There are many additional benefits you may find in your policy, such as unlimited access to a digital GP or an annual health check. The good news is, using these services aren't classed as making a claim and won't affect your claims status. So you can still access 24/7 healthcare and support on your policy to help to keep your health on track.
When you take out a health insurance policy, you will choose a level of excess.
Typically excess can range from £0 to £5000, depending on the insurer and policy. By agreeing an excess, you agree to pay that amount towards the claim.
Whilst this may mean paying more when making a claim, going for a higher excess can help to reduce health insurance premiums. You may choose a lower excess meaning a slightly higher premium, but benefit from peace of mind you can afford your excess if you do need to make a claim.
The claims process does vary depending on your chosen health insurer, however, you may expect the following to take place.
To begin your claim, you’ll need to visit your GP. This could be your NHS GP or you can also use your digital GP provided by your insurer in some cases. You may find using your digital GP offers quicker access to an appointment and getting the treatment you need.
This step is needed to ensure you have been assessed and referred for the most suitable treatment with a provider.
If you visit your own GP, you’ll need to let them know that you have an active health insurance policy and need an open referral.
This will ensure that you can see the right specialist at the right facility for you. An open referral states what medical specialism or type of treatment is required, but won't include a consultant or facility for treatment.
You'll then have the option to choose where you're treated and who by, depending on the hospital list available to you on your policy.
Your digital GP will also be able to give you an open referral.
There are some instances where you may not need a GP referral and can go direct to your insurer for an appointment, however, this only covers certain health conditions. For example, Bupa offer direct access for cancer concerns, helping you to get fast access to treatment.
You’ll then need to check that your treatment is covered by your policy. It’s easy to do this by getting in touch with your insurance provider and sending them your referral letter.
Most insurers have an online portal or app where you can do this, making it easy for you to move forward with treatment. You can also call your insurer and they’ll support you through the steps of getting pre-authorisation for your claim.
Once you have confirmation that your treatment will be covered by your policy, you can then go ahead and attend the appointment required.
Whilst it varies depending on your insurer, you may need to take certain things to your appointment with you, such as:
You’ll get to choose where you want to be treated based on your hospital list. This gives you flexibility and freedom to choose a facility and specialist that best suits you.
If you have something called a 'guided list', your insurer will give you a shortlist to choose from, with slightly less choice.
Once your treatment is complete, it will then be time to settle your bill.
In most cases, your insurer will pay the specialist or hospital directly following your appointment. If you need to pay an excess or anything towards the bill, your insurer will let you know and manage the payment for you.
A health insurance claim can get rejected, and there are several reasons why it may happen. Some of the main reasons for rejected claims include:
This is why it’s essential to know exactly what you’re covered for and take the time to get the right policy with the right level of cover for you.
Using a free health insurance comparison service, like Usay Compare, offers complimentary advice and recommendations to ensure you get the best policy with the best cover, at the best price.
In most cases, policies allow you to make a claim as soon as needed once you start paying your premiums.
We’d always recommend checking the full details of your policy, however, to know exactly when your cover starts and if there are any waiting periods you need to be aware of.
You may find some types of claims won’t be accepted until you’ve had your policy for a certain amount of time.
Any pre-existing conditions you’ve had before taking out the policy typically wont be covered at first. However, with moratorium underwriting, you may find the condition does become covered after going a certain period of time without having symptoms, medication, advice, diagnostics or treatment for it. Learn more about moratorium underwriting.
Making a claim on your health insurance policy will likely mean your premiums increase at renewal. This is due to a number of reasons including: losing your no claims discount (NCD) by making a claim or increased risk of needing to claim again for additional treatment.
It is worth considering your options and doing a comparison when you come to renew, to see if you're still getting the best policy at the best price.
If you find your circumstances have changed and you're no longer on the most suitable policy, switching health insurance is really simple when you use a free comparison service. In fact, you don’t actually need to do anything! We do everything for you, from comparing, to recommendations and sorting out all of the paperwork.
It may be that switching isn't the best option for you right now, but we'd always recommend a free consultation to consider what options are available and if a different provider could be offering you better coverage or benefits.
Fill out the form below to get a quote or give us a call on: 01285 864670.