How to Make a Health Insurance Claim

In order to make a health insurance claim it is very important to follow the correct procedure for each company.Doint this helps speed up your claim and avoid misunderstandings.

Having a good knowledge of your policy is probably the first step. Having an awareness of what you are and are not covered for will help you to have the correct expectations of your private medical insurance cover.

Your policy will also have specific details of how to make a claim. Being familiar with your policy claims proceedure is important as there are variations in what health insurance companies need to you to do in order to make a claim. Errors can cause distressing delays and misunderstandings.

The following details are a general guideline only.

The GP is always your first port of call. They are the ones that refer you for a consultation or treatment if they think this is necessary. You need to inform them that you would like to go via your medical insurance.

Normally your insurance company will provide you with a list of approved hospital networks and practitioners with which you will be covered under your policy. Your GP needs to refer you to establishments or individuals that will be accepted by your insurer.

Some companies, for example Bupa, will allow you to go to hospitals which are not on their approved lists but will not cover you completely for treatment there. They will give you an allowance instead. If the hospital you go to charges more then you have to pay for the difference.

The next step is to call your insurance company. They will let you know whether the treatment you need is covered by your policy. They will also advise you as to whether they can approve your chosen practitioner.

The insurance company may also then send you a claim form which you need to fill in and return to them. The next step depends on whether you have a moratorium or fully underwritten policy. If you insurance cover is under a moratorium policy then the insurance company sometimes need check your medical history with your GP to make sure that you are covered for treatment for the condition you are presenting with. This can delay their response.

When you go for your consultation or treatment you need to take your health cover details with you and show them to your consultant. In most cases this enables your health insurance company to be billed and not you.

With some types of health insurance policy you are given money directly by the insurer and then you are responsible for paying for your healthcare directly. This is unusual however and in most cases the medical insurance company pays.

If your consultant sends you for tests or hospital treatment you have to contact your private health insurance company again in order to check that the proposed treatments are covered.

When you go to hospital or for treatment you need to present your health insurance documents so that your bills are sent straight to the insurance company. After you have completed your treatment you will only have to pay for any outstanding personal expenses such as guest meals, telephone calls and newspapers.

If you have had any treatment that is not covered under your policy you will also have to pay for this. Normally your medical insurance company will alert you to the fact that you have an outstanding balance.

If you feel that your health insurance company should pay for something and they are saying that it is not covered, you do have redress. You can appeal to the company to review your claim. If you are still not happy you can complain via their official complaints procedure. If you are still not happy with the outcome you can take if further to the Financial Services Ombudsman.