Private Medical Insurance Individual Claim
As a result of longer wait times to visit a doctor, an increasing number of insurers have established online medical services for appointments and video consultations. If necessary the online doctor can refer you to a specialist and provide prescriptions. You can book an appointment easily and you will have the choice of either a video or telephone appointment.
Please check with your insurer to see if this is something you have access to.
If your GP refers you to a specialist, make them aware that you have Private Medical Insurance. Once your GP provides you with a referral*, you must then contact your insurer to pre-authorise treatment.
Please remember that you must always pre-authorise all treatment with your insurer prior to attending any Specialist appointments or receiving treatment.
* See below for the different types of referrals
Before you see your chosen specialist you must obtain authorisation from your insurer. When you call them, be sure to have your policy number to hand. They will also ask you about the condition you are suffering from, details of your symptoms and when they first began, details of when you visited your GP and details of any treatment that has been recommended. Your insurer will confirm if you are covered and if so, they will provide you with an authorisation number. You’ll need to take a note of the authorisation number to your appointment.
If you require any further treatment it is important to keep your insurer updated to confirm that any additional treatment is covered. Your insurer may provide you with an additional authorisation code.
Your insurer may allow you to refer yourself for some symptoms. This means you do not have to see your GP first. Self-referral is allowed by some (but not all) insurers for muscle, bone, and joint ailments, as well as mental health issues and some suspected cancers.
Calling your insurer’s claims department should be your initial step to ensure your policy cover allows self referral.
If your GP refers you to a specialist, make them aware that you have Private Medical Insurance. Your GP will then provide you with the names of some recommended consultants.
When you call your insurer to authorise your claim, they will check if the consultant and hospital are covered by your policy. If your insurer does not cover the specialist or hospital, they will assist you in finding an alternative.
If you wish to select and source your own specialist consultant, then you should ask your GP for an ‘open referral’. This will allow you to contact a consultant of your choice and book your own appointment.
Make sure the consultant and hospital is recognised and works with your insurer, then call your insurance company to have the claim authorised.
Some insurance companies now offer (usually at a reduced premium) polices where they stipulate which consultant and hospital to choose, in the main they will however offer you multiple choices. If you have one of these polices, you should ask your GP for an ‘open referral’ and then make contact with your insurance company.
