If you’ve currently got a private medical insurance policy with us, or you are thinking about taking out cover, but you’re unsure of how to make a claim then we’re here to help demystify the process.
In four easy steps you can have peace of mind that when it comes to claiming you know what to do and how to keep us informed along the way.
Your first step is to arrange an appointment with your GP who will refer you to a consultant if needed.
There are two types of referral that you might be given: open referral or a named referral.
The GP hasn’t named a particular specialist that you must see. In this instance we can help you locate someone suitable to oversee your care; we’ll be able to tell you this over the phone.
If the GP has named who they want you to see then let us know, as we’d need to check to make sure they’re someone we are able to cover in full for you.
Please note we are unable to provide cover for GP referred scans or blood tests – this is considered primary care – however, we can step in once it is necessary for you to be referred to a consultant.
We can also consider referrals if you have been referred to a specialist by Dr@Hand or your A&E department.
If your claim relates to Musculoskeletal, Skin or Breast conditions we may be able to refer you to one our specially designed pathways without the need of a GP referral, please call our claims team to find out more.
Once you have a referral in place, give us a call. We will have a chat with you about your medical condition; we may be able to approve your treatment over the phone but may also need to request medical information from your GP in order to assess the eligibility of your claim first.
We’ll be able to confirm this when we speak to you.
If medical information is required, once it has been sent to us by your GP, we will review it for you within 3 working days and contact you with an update
Once your claim is agreed, you can then go ahead with your treatment. We just ask that you keep us up-to-date with the progress of your care, so we are able to confirm any additional treatment will be covered in full.
If you have a specialist in mind please call our Claims team to see if your chosen specialist is covered under your policy. If so, we can cover their costs in full – subject to benefit limits and excess.
If you would like to see a specialist who is not a named specialist on your policy, but is recognised by AXA PPP healthcare, we will pay 60% of the charges that would normally apply. You will be responsible for paying the remaining charges.
For example: a patient visits a specialist who is recognised by AXA but who is not a Health for You specialist. The specialist charges £1000 for the operation. The AXA rate for that particular operation is £800 - therefore we would pay 60% of the AXA agreed rate. In this example 60% of £800 = £480.
If your specialist is not recognised by Health-on-Line, or AXA PPP healthcare, you will be responsible for paying the charges in full, so do check with our claims team first.
Specialists and hospitals normally send their bills to us, so we can pay them directly. If you need to pay an excess, we will let you know how to pay it.
You can find the nearest hospitals to you, that are covered under a Health for You Policy, by using our Private Hospital Search. You can also find the nearest hospitals to you, covered under a Personal Health Policy, by using the AXA PPP healthcare Hospital Search.
If you already have Private Medical Insurance and need to make a claim or need any help then please call our team on 0345 600 1292 (Monday to Friday, 8am until 6pm) or email us on email@example.com.
Or if you’re thinking about taking out a policy with us and want to know how much it would cost then get a quote online in a few easy steps.