The Private Health Insurance Claims Process Explained

The claims process always starts with a medical consultation. You can use your insurance policy's integrated 24/7 Private Remote GP app or see your traditional local NHS doctor. If you choose the remote digital GP app, appointments are typically available on the same day and no policy excess is ever applied for utilising the virtual consultation service, making it a quick and easy way to get your initial assessment. If the doctor determines you require specialist diagnostics or treatment, request an 'Open Referral' letter stating the specific medical specialty needed (such as 'Orthopaedic Consultant') rather than naming a specific individual specialist. This open framework gives you total flexibility, allowing your provider to search for the fastest available private appointment slots in your local area.

Before booking any appointments, call your specific insurance provider's dedicated claims helpline or log into their member portal to present the details from your open referral letter. Because most UK policies utilise Moratorium underwriting, the claims desk will not instantly authorise treatment over the phone. Instead, they will initiate a standard medical history check, requesting confirmation from your GP that you have experienced no symptoms, advice, or treatment for this specific condition in the 5 years prior to your policy start date.

Once the insurer verifies your medical history and formally approves the claim, they will unlock your hospital access list (such as Essential, Standard, or London Premium) and issue a unique Pre-Authorisation Number (often called an authorisation token or treatment code). Take this reference number and give it straight to your private consultant's secretary or the hospital reception desk. This code ensures the hospital bill is paid directly by the insurance provider, meaning you do not face any unexpected personal bills or out-of-pocket expenses.

With your pre-authorisation locked in, you have total control over your care. You can book your private consultant appointments, scans, or surgical treatments completely around your own diary, business commitments, and family life. You bypass the standard NHS backlog queues entirely, undergo your recovery inside premium clinical suites, and get safely returned to full operational health on your own schedule.