How to Claim on Private Health Insurance: A Step-by-Step Guide

A lot of people put off using their private health insurance because they’re not sure how claiming works — and worry they’ll do something wrong and end up with a bill. In reality, the process is more straightforward than most expect, as long as you follow the steps in the right order. Here’s exactly how to claim on private health insurance, step by step, plus the pitfalls that cause delays.

Step 1: See a GP and get a referral

Most claims start with a GP — NHS or private. You see your GP about the problem, and if you need to see a specialist or have tests, they provide a referral (an “open referral” to a type of specialist, or a named consultant). This referral is the starting gun for a private claim, and insurers will almost always want to see one before authorising treatment. Many policies now include a digital GP service, which can speed this step up.

Step 2: Call your insurer BEFORE booking treatment

This is the single most important step, and the one people most often get wrong. Contact your insurer (or your broker) for pre-authorisation before you have any treatment. You give them the referral details and what’s been recommended, and they confirm what’s covered and issue an authorisation/claim number. Booking treatment first and asking questions later is the most common way to end up with a claim problem.

The golden rule of claiming: get pre-authorisation before you’re treated, not after. It’s the step that turns “I hope this is covered” into “this is covered.”

Step 3: Get your treatment

Once authorised, you book in with an eligible consultant at a hospital on your policy’s list, and get treated — usually far faster than the NHS equivalent. Your broker or insurer can help you find an in-network consultant if you’re not sure who to see.

Step 4: The bills get settled

Here’s the reassuring part: for authorised treatment, the hospital and consultant usually bill the insurer directly. You typically don’t pay the big costs upfront and claim them back — it’s settled behind the scenes. The main thing you might pay is your excess (your agreed contribution towards a claim) and anything not covered by your policy. Always check what your excess is so there are no surprises.

How to avoid a declined or delayed claim

Most claim problems come down to a handful of avoidable mistakes:

• Skipping pre-authorisation — get the claim authorised before treatment, every time.
• Non-disclosure — if you didn’t fully disclose your medical history when you applied, a claim linked to that can be refused. Always be complete and honest upfront.
• Going out of network — using a hospital or consultant not covered by your policy can leave you with costs. Check first.
• Claiming for an excluded condition — chronic, pre-existing or excluded conditions won’t be covered; know your policy’s limits.

Where a broker helps at claim time

This is one of the quiet advantages of buying through a broker rather than direct. If a claim is confusing or gets queried, you’ve got someone who knows your policy and can help you navigate it — rather than facing a call centre alone. It’s exactly the sort of support that matters most at the moment you actually need your cover.

Cover that’s easy to use when it counts

A good policy is one you can actually use without stress. ComparePMI compares a wide panel of insurers and explains how claiming works in plain English. If you decide to go ahead, we introduce you to an FCA-authorised firm who arranges your cover and can help if you need to claim. It’s free and there’s no obligation.