Submitting Insurance Claims
The process of submitting insurance claims can vary greatly from one health insurance provider to the next and from one type of insurance policy plan to the next. When you're shopping for private medical cover, consider the insurer's claims process and reputation for approving claims as well as the cost of your coverage. A cheap private health insurance policy will not prove valuable if your claims for physicians services, hospital costs, procedures or diagnostic tests are consistently denied.
Requesting a Referral
Private health insurance providers work alongside the National Health Service to provide a wider range of inclusive benefits to their members. With most standard private health insurance policies, the first step in seeing a specialist or receiving a specific treatment or procedure is to see your general practitioner, or GP. Whilst it is possible to find a GP on private health insurance, many members see GPs on NHS.
If you have a medical concern that requires a specialist consultation, such as persistent back pain or difficulty swallowing, your GP will give you a referral letter recommending that you visit a specialist. Unless you or your GP already has a specialist in mind and you know that this professional is included in your insurer's network, the safest approach is to request an open referral. An open referral describes the condition that requires further evaluation, but does not refer the patient to a specific doctor or hospital.
After you've received your referral letter, you must contact your private health insurance provider to make a claim. Phone your provider at the claims number listed in your policy booklet or on your membership card. You will be asked to provide details such as your policy number, the nature of your condition, the date you visited your GP and the date and nature of the proposed treatment. If your GP recommended a specific practitioner, you must provide this doctor's information, as well.
Health Insurance Claims Process
Before authorising your consultation or treatment, your provider will advise you on whether the recommended treatment or practitioner are covered under your policy. If your claim is approved, you may receive a pre-authorisation number for your upcoming visit. When you schedule your appointment, the doctor's secretary or facility may request a pre-authorisation number to verify your claim.
After you have consulted with a specialist, you must notify your insurer if the practitioner has scheduled additional tests, surgery or other procedures. At each step of the diagnostic process and subsequent treatment, you must keep your insurer informed and request authorisation for services. Policies vary in the degree of flexibility and the range of choices they offer their members, but in most cases, authorisation for treatment must be given in order for a claim to be paid.
Once you've received treatment, the practitioner or facility will bill your insurance provider directly in many cases. The pre-authorisation number should be attached to the invoice as a record for your insurance company. After reviewing the claim, your insurer will make a final authorisation of payment. Members should be aware that even if a claim has been pre-authorised, there may be a chance that the claim will be denied. Following referral procedures closely and maintaining contact with your insurer will help you to ensure authorised payment.
Submitting insurance claims should be an easy process. Claims representatives should be helpful and willing to answer your questions or address your concerns. Efficient claims management is a key feature of the best private health insurance companies. Finding a provider that simplifies the claims process for its members is a plus when you're searching for private health insurance.
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