How do I make a claim? - Private Medical Insurance

Apart from emergency admissions to NHS hospitals, all medical treatment has to start with a referral by your GP to an appropriate specialist.

You:

Before you receive any treatment privately, you should call your insurance company to check that you are covered for the treatment that you will receive. In fact, some insurance companies insist that you do this.

You will then need to complete a claim form which will include a patient section that you complete, and a GP section that will need to be completed by your doctor. The patient section will usually ask for your name, date of birth, contact details, insurance policy number and a description of your medical condition.

The GP section will normally ask for details concerning patient symptoms and their medical condition, as well as information about your initial consultation. It will also include information about the surgeon to be used and fees. Your GP may charge a small fee to sign it and this will not be covered by your insurance. The GP will have to sign the form.

Your specialist may then recommend tests, admission to hospital as an in-patient, or day-case treatment. Most hospitals and some specialists have their bills paid directly by the insurance company. Others will send the bills to you.

Your insurance company:

Your insurance company will give you all the guidance you need, confirm what your cover includes and, if necessary, send you a claim form. Stay in contact with your insurance company, who will confirm that any treatment you plan to receive is within your cover.

Your insurance company will tell you how they pay claims. Remember, if you have chosen to pay an excess, you will still have to make that payment.

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