Health insurance Claiming on your health insurance

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Making a health insurance claim can be straightforward. Follow this step-by-step guide.

1. Read your policy document

Different health insurers have different claims processes. If you're planning to seek private treatment, read the small print of your policy or check your insurer's website to see whether there's specific guidance.

2. Speak to your GP

Start by speaking to your GP about your condition as you normally would. Your GP can refer you for private treatment. There are two main types of referral; an open referral, where your GP doesn't address the letter to a specific consultant, or named referral, where a specialist is listed on the letter. Read the terms and conditions of your policy to check which one your provider will want.

3. Call your health insurance provider

Next, call your provider and explain the situation. What you'll need when you call will differ from provider to provider, but consider the following:

  • Your policy number
  • Details of what your GP told you
  • Details about your condition
  • Details of your referral.

4. Call your health insurance provider (again) once you have seen a specialist

Once you have seen a specialist, call you provider again to let them know what steps will be taken next. Also, make sure you understand how you'll pay for any consultations or treatment – either you'll have to pay and claim the money back, or you'll provider will pay directly.

5.  Don’t be afraid to complain

If your claim doesn’t pan out as you expect, or you feel that your insurer has treated you unfairly, don’t be afraid to complain. Speak to your provider first, but if it isn't proving helpful (and you have exhausted their complaints process) take the matter up with the Financial Ombudsman Service by calling 0300 123 9123.

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