Making a Claim on Private Health Insurance
Different insurance companies have different policies when it comes to the time to make a claim, so you should read up on your policy carefully.
When You Need Treatment
In general, medical treatments will begin with a referral by your GP. At this stage you will know which treatment you need before you receive it, and should call up your insurance provider in order to check that the treatment is covered under your policy.
You will be given a claim form, which you will then need to get your GP to fill in a sign. GPs will often charge a fee for these forms, and this fee will not be covered under your insurance. Details of your specific course of treatment will also be given, including tests you may need, whether you'll be admitted to hospital or receive outpatient treatment.
The Payment Process
The way your treatment is paid could be that your costs are paid directly from the insurance provider to the hospital. However, you may have the hospital bill sent to you and need to be reimbursed by your insurance provider. At this stage you will also need to make sure that you can afford any excess that you have agreed to.
It is important to make sure you contact your insurance provider before going ahead with any treatment, to ensure you follow their specific guidelines for receiving claims and to make sure you understand just how the payment will be made.
You will be given a quote in advance, and your insurance provider should also confirm at each stage of treatment what is and what isn't included under your insurance policy.
Protecting Your Information
When you sign up to an insurance policy, or when it comes time to make a claim, your data will always be protected under strict guidelines. This means that all forms you fill in for treatment will be treated as important documents and you must fill them in accurately and honestly or you may not receive payment for your claim.
All of your details and medical information will be held in confidentiality. If you have any complaints regarding your information or claims, then you should look up the contact details of your insurance provider and follow any procedures they have in place.
Additional Points to Remember
If you are being billed directly by the hospital, then you should make sure that your bill is itemised and includes details of every aspect of the treatment you are receiving. This ensures you and the insurer knows the exact costs, and can pay the correct amount for each item that is covered under your particular insurance plan.
You should also make sure to keep copies of every form you fill in, for your own records. This includes the initial claim form, as well as your bills and any other relevant information. If you ever need to repeat the claim for some reason, this ensures you'll have the full information at hand.
What if Your Claim is Denied?
As many as a fifth of health insurance claims will be denied - but this is usually as a result of pre-existing or excluded medical conditions, as well as not understanding the fine print of the insurance policy. However, in many cases it is worth going through your policy carefully. If you still believe you have a case then legal representation may be sought after first asking your insurance policy for reconsideration.
In order to avoid your claim ever being denied, it's worth asking your insurer about any terms in the fine print that you do not understand, before taking out your insurance policy.