How do I make a claim on my Health Insurance?

You’ve done the right thing by making sure you have a good health insurance policy in place. You probably thought you would never need to use it, but the unfortunate has happened and you now need to make a claim on it.

What next?

You didn’t ever think you’d need to use it, so you didn’t keep all the original paperwork explaining how the claim procedure works, so how on earth do you go about making a claim?

That is where we can help!

We have put together an easy step-by-step guide about how to claim on your health insurance; to make, what is likely to be, an already anxious time into a smooth, hassle free process.

It goes without saying that every insurance company will have their own claims procedures, however most tend to keep to the following steps:

GP referral

Firstly, you need to visit your GP to determine whether they think you need to be referred to a healthcare professional or specialist consultant based on your symptoms. If this is the case, you will need to check with your health insurer as to whether your policy has a list of particular consultants you must use. Some providers, such as Aviva, have a Specialist Finder Tool app, which you can download and allows you to view a selection of suitable specialists that are available to you. Some GP’s may have their own recommendations or if you ask for a private ‘open referral’ you will have the freedom of any consultant. This is a great option for certain policies as some insurers, such as AXA, have a Fast Track Appointments team, who are able to track down the most conveniently located specialist to you, which can make life a lot easier. Always check with your provider to ensure you are sticking to the rules of your policy, because if you do inadvertently see a specialist who is not listed you won’t be covered and will end up having to pay.

Do I need a referral?

Although most health insurance claims need to be backed up with a referral from your GP, there are certain conditions where you may not need one. These are usually for things such as:

Muscle, joint or bone conditions
Cataract procedures
Mental health conditions

Again, this will vary between insurers, but some, for example Bupa, will assess your conditions via a telephone consultation and refer you to their own specialist therapists.

Can I get a second opinion?

If for whatever reason you don’t agree with the diagnosis, proposed treatment plan or advice that either your GP or specialist consultant/therapist has given you, you are of course entitled to a second opinion. Some providers will have a Second Opinion Service written into their policies, for which they will cover the cost of a second consultation and any tests in connection with this. You should not need to pay any excess for this and it should not effect your out-patient entitlement.

Speak to your insurer

It is absolutely crucial that you keep your health insurance provider in the loop with as much information as you can give them and to discuss your requirements, before you take the next step. They will need to authorise your treatment based on any referrals they have received for you and to establish whether they need any further information from your GP. If you go ahead with any treatment before your claim has been officially authorised you may well end up having to finance the costs yourself. You must also ensure you keep your insurer update to date with of any changes to your treatment, as this will naturally effect the cost and may affect the overall claim you are entitled to.

What information will I need to give?

When you contact your health insurance provider they will ask you for your membership number in order for them to locate you on their database, so make sure you have this to hand before you ring them. Once they have found your profile they will need the following information from you:

the date of your treatment
details of the procedure
the charge for each service, e.g. the consultation
the total of all the charges.

There to help

You must remember that your health insurance provider is there to help you; you are their customer. The team of people who answer the phone and go through the claims procedure with you should all have received training to understand the different unique claims as well as being friendly and sympathetic to your needs. Some will have designated teams of people for different types of health claims for example, there may be a team specialising in oncology, a team for women’s health, in which a female staff member would be the point of contact or a psychiatric team that are understanding and sensitive at what is likely to be a particularly difficult and confusing time.

Why have I received an invoice?

If you have followed the above steps correctly, then there is absolutely no reason why you should be sent any kind of invoice for your treatment. If, however, you do get sent one you should contact your insurance provider to find out why this has happened.? More often than not it will be down to human, or in fact computer, error and it should be sorted out quite easily, so please don’t be alarmed.

Get better

Now that you have followed the steps to making a claim on your health insurance you can sit back, relax and focus all your energy on getting better, with the peace of mind that you don’t need to worry about any of the financial side of things. Health insurance is there to take the worry away from you at a time when you are sure to be worried about a lot of other, more important things.

For more information and advice on how to save money and how to search for better deals on your health insurance read our article Get a better deal on your Health Insurance TODAY!.