MEDICAL INSURANCE CLAIMS
The process of making a claim:
How to get a referral for private healthcare.
Primary healthcare providers like GP’s, Therapists or Dentists can refer patients for a wide range of private healthcare services. Tell your medical practitioner that you’ve got medical insurance and if needed they can refer you to see a consultant.
There are four referral options:
1. Self referral
- Some (but not all) insurers will allow you to self-refer for muscle, bone or joint symptoms as well as mental health problems and some suspected cancers.
- Your first action should be a call to your insurer’s claims team.
2. Virtual GP
- In response to increased waiting times to see a GP more and more insurers are setting up online doctor services for appointments and video consultations. In some cases the online GP can give you a referral to see a consultant. We’d recommend visiting your mobile phone app store or see the links below to see if this service is available from your insurer.
For Aviva Digital GP, check your app store.
3. GP named referral
- You will get a referral letter to see a named consultant, contact the insurer to obtain authorisation.
- If the consultant or hospital is not covered by your policy, they will help you to find an alternative.
- The insurers have fee guidelines and pay fair and reasonable costs. If your consultant’s charges are above these limits there will be a shortfall which will be your liability.
- The claims advisor will help you to avoid any extra costs.
4. GP open referral
- Your referral letter specifies the type of consultant only and will not name a specific specialist.
- The claims team will help you choose your consultant and facility.
- You may find it useful to use your insurer’s online facilities finder to research nearby hospitals and specialists.
- Certain policies only cover open referrals and not named referrals.
- With Open Referral policies the premiums are usually lower however you are giving up some of your choices of who to see and where.
- The consultants work within your insurers’ cost guidelines and you won’t end up with a shortfall.