How to claim on your health insurance

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How to claim on your private medical insurance

It’s easy to claim on your private health insurance policy, should you need to. We’ve written this simple step-by-step guide to help you through the process.

The claims process

1. Read your policy document

The claims process may vary depending on the company you’re insured with. Your policy document – or the insurer’s website – will contain full details of the steps you need to take to make a claim.

2. Visit your GP

Talk to your GP about your health condition, as you normally would. He or she will refer you for private treatment using either an open referral (where the GP doesn’t address a specific specialist or consultant) or a named referral (where they refer you to a specific specialist or consultant). Your policy terms and conditions will explain which type of referral your doctor should use.

3. Phone your health insurance provider's claims team

Call your PMI insurer’s claims team, making sure you have the following information to hand:

  • Your insurance policy number (located in your policy documents)
  • Details of the symptoms and when they started
  • Details of what your GP has told you about the condition
  • Information related to your referral, including the name and location of the specialist on the letter, or, if your GP made an open referral, the required specialism/sub- specialism
4. Get diagnosis, treatment or surgery

If your specialist arranges treatment or surgery for your condition, you will need to call your PMI provider’s claims team and tell them:

  • Where you’re being treated or undergoing surgery
  • When you plan to have the treatment or surgery
  • The procedure (CCSD) code from your specialist
5. The insurer pays the bill

Most specialists will send their bill straight to the insurer. If they do bill you direct, either ask them to send a copy to your insurer, or forward the bill to your insurer’s bill payment team.

You can find a list of our insurers and their contact information on our insurers page.

Useful health insurance guides

We know insurance isn’t always the easiest subject to understand, so we’ve produced a range of helpful, plain English guides to clear up any confusion and answer your questions. Choose a guide from the list below to find out more about private medical insurance.
View all the guides

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