PRIVATE HEALTH INSURANCE

When buying insurance we all hope that we’ll never need to claim against it however if you are unwell we have put together four simple steps to guide you through this process. Don’t forget that if you need extra assistance then we are here to support you.

1

See your GP

You should always see your GP as quickly as possible if you are unwell and if you have any health worries. They’ll talk to you about your symptoms and a possible diagnosis . Let your GP know that you’ve got medical insurance . They’ll also tell you if they think you need to be referred to a specialist for further investigations or treatment.

Ask your GP for;

  • Full details of your condition/injury.
  • Diagnosis and intended treatment.
  • Full name and address of the specialist or therapist and the hospital/clinic you’ve been referred to.

Then when you have your referral letter please call your insurer to discuss the details of your claim and to check that the costs will be covered under your healthcare policy. You can also check with your insurer verbally and online (via their consultant/hospital finder or app) that the chosen specialist is covered within your policy. If the specialist that you’ve been referred to is not covered within your policy you will be offered an alternative.

I don’t have cover for diagnostic consultations?

If you have a medical insurance policy with no “outpatient cover” or no cover for out-patient diagnostic consultations then you either have the option of self-paying for the consultation or utilising the NHS. If the consultant then recommends treatment and the treatment is covered within the terms and conditions of your policy then you will have the treatment privately.  Please don’t delay seeing a consultant if you are unwell.

 

Shortfalls

There are currently more than 21,000 consultants in private practice. These consultants are self-employed practitioners who practice out of the circa 600 private hospitals within the UK and the fees that these consultants (and their anaesthetists) charge can vary considerably. Please be aware that some consultants only practice within certain hospitals and it’s important to ensure that the desired consultant is accessible via your insurer’s hospital list.

 

A “shortfall” could occur when there is a financial difference between what a medical practitioner charges for your treatment and what your medical insurance company is prepared to pay. In the last few years, some insurance companies have adopted a fee assured system or a capped payout scheme. The companies set the fee for a named procedure and the total price is only covered if you choose a consultant who agrees to work for that set fee. The fee proposed by their chosen specialist may be outside of their fee schedule resulting in a claim shortfall with the extra having to be paid directly by you.

 

 

But how can you avoid a shortfall?

Our advice is that if you intend to be treated privately first check that you’re fully aware of the fees to be charge and then liaise with your insurer to ensure how much of your treatment will be covered. Include fees for things like anaesthetists and assistant surgeons that can quickly bump up the costs.

 

Ring your insurer or go online (using the hospital/consultant finder or app HYPERLINK) and check that your consultant is on your chosen hospital list and that his fees fall within their fee agreements. Speak with your insurer who will give you guidance. Explain the situation and see if they can offer any advice to resolve the problem. If you have chosen a named consultant that is not on the list provided by the insurance company, you could find out more about the other consultants that the insurer has offered. If there is a doctor that you would be equally happy with, it may be possible to arrange the treatment with them.

2

Ring your Insurer

Ring your insurer on their claims line. When speaking with the insurer you will need;

  • Your policy number.
  • Full details of your condition/injury.
  • Exactly what the GP has told you- including the diagnosis and intended treatment.
  • Full name and address of the specialist or therapist and the hospital/clinic you’ve been referred to.
  • Details of when you first consulted your GP about your symptoms.

Your insurer will ask you a few questions so that they can authorise treatment under your cover. They will check your hospital list entitlement so as to ensure that the specialist that you’ve been referred to is covered within your policy- if not they will suggest an alternate specialist to ensure you do not face a “shortfall” –please see the section on hospital lists and shortfalls. Sometimes your insurer may need more information from your GP or specialist in writing. When they do require this they will need your consent.

In some cases they will ask you to complete a claim form to register your claim. Once you’ve sent in your form your insurer will make a decision as soon as possible and confirm with you whether you are covered.

3

Visit the specialist

Once your claim has been approved you can visit the specialist –please remember to take your membership number and pre-authorisation number with you when you visit your specialist so that the insurer will be able to settle the hospital costs directly. Don’t forget if you have an excess or shared responsibility that you may well be asked to pay that amount to the hospital direct when you visit.

4

Get Well Soon

Now that you’ve been treated it’s time to focus on getting better Once you’ve been treated we wish you a speedy recovery. Please email us and keep us informed and we will update your health notes on our system.

Cash plans, Excess & Shortfall Insurance

Health Cash plans are simple, effective health insurance plans enabling you to claim cash towards your everyday healthcare expenses. They provide a number of routine health benefits, such as therapies cover, money back towards dental treatments and check-ups alongside optical tests and prescription eyewear. The claims process is designed to be both simple and speedy.

In the first instance you should check the terms and conditions of your policy to ensure the treatment is covered (if in doubt call the provider directly) then you simply self-pay for the treatment then send or submit online the original receipt alongside the completed claim form to the provider who will then pay the monies directly to the designated bank account.

Please note that all cash plan providers require original receipts whilst with most cash plan providers there is a time limit (typically about 90 days) as to how long after you’ve had the treatment that you are still able to claim. Don’t leave it too late!

Claims – Cash plans, Excess & Shortfall Insurance

InsurerPhone NumberMore Information
The Exeter0300 123 3256Making a Claim
Simply Health0370 908 3481Making a Claim
HealthShield01270 588555Making a Claim
Medex Protect0800 787 9304Claim Form
Westfield Health0114 250 2000Making a Claim
BHSF0800 622 552Making a Claim
MediCash0151 702 0265Making a Claim

Important Contact Numbers

 

Claims – Individual & Family Policies

InsurerClaims lineHospital finderMore Information
April0203 819 7159Hospital ListHow to make a claim
Aviva0800 068 5821Aviva Hospital SearchHow to make a claim
AXA-PPP0800 132 203AXA Hospital SearchHow to make a claim
Bupa0345 609 0777Bupa Hospital Finder How to make a claim
Vitality0345 602 3523Vitality Hospital SearchHow to make a claim
Freedom0800 999 2013A Hospital of your choiceHow to make a claim
PHC0800 068 7111Hospital ListHealthCover4life Details
WPA0345 122 3100Hospital SearchHow to make a claim

Claims – Business Policies

InsurerClaims line
Hospital finderMore Information
April0800 028 0849Hospital ListHow to make a claim
Aviva0800 158 5182Aviva Hospital SearchHow to make a claim
AXA-PPP0800 389 7413AXA Hospital FinderSee Membership Documents
Bupa03452 668 974Bupa Hospital FinderSee Membership Documents
Cigna01475 753333Login to your Member PortalMember resources
Freedom0800 999 2013Hospital ListHow to make a claim
PHC0800 068 7111Hospital ListHow to make a claim
Vitality0345 602 3437Vitality Hospital SearchHow to make a claim
WPA01823 625270Hospital SearchHow to make a claim

Claims – Dental Insurance

InsurerPhone NumberMore Information
Denplan01962 828 007Denplan How to claim and FAQ
WPA0800 298 9 588Making a Claim
BUPA0800 0121 271Making a Claim
CALL ME BACK