Make a health insurance claim

How do you make a health insurance claim?

When you’re unwell and need to make a claim on your health insurance, we’ll do all we can to get you the healthcare you need, as soon as we can.
Here’s how you make a claim in four simple steps – and a few things to keep in mind along the way.

1. Ask your GP for a referral
First of all, see your GP, or use our digital GP app, and they’ll refer you for any investigations or treatment you need. Be sure to tell them you have private health cover with us.

There are two types of GP referral:
• An open referral is where your GP says what kind of treatment you need, but doesn’t name a particular specialist or hospital.
• A named referral is where your GP gives the name of a specific specialist, at a particular hospital. Though you’re not bound by this, and we can offer you other options, if needed.

It’s a good idea to ask for an open referral, so there’s more flexibility with where you’re treated. If you have Expert Select or Optimum Referral, you’ll need an open referral.

If your cover includes BacktoBetter or our Mental Health Pathway, you don’t need a GP referral to make a claim for musculoskeletal or mental health symptoms – just call us direct through MyAviva - your secure online account, or by phone.

Remember! Get in touch with us before you have tests or treatment, so you know they’re eligible for cover. That way, you won’t have any unexpected costs.

2. Start your claim and we’ll get things moving
The easiest way to start your claim is through MyAviva. When you log in simply select your policy or scheme and you’ll see the option to start your claim. Alternatively, you can also start a claim over the phone.

Whichever way you choose, we’ll ask you about your symptoms and explain the best next steps, in line with your cover. We’ll also guide you through the process and answer any questions you have.
Sometimes, we ask for more information to get a better picture of your condition. Otherwise, we aim to make a decision on your claim straight away, explain which tests and treatments we can pre-approve and connect you with the hospital or clinic to book your appointment there and then.

Where will you get your treatment?
You’ll either see a specialist at a hospital on your list, or, if you have Expert Select or Optimum Referral, at a choice of hospitals we’ll help guide you towards. If it’s available, you could get treatment at a facility that has expertise in treating specific conditions, like cataracts or knee pain.

The nationwide hospitals we use are based on ratings from independent regulators, like the Care Quality Commission – with most rated outstanding or good. We’ll also only recommend specialists who meet the standards of their relevant professional governing bodies, like the General Medical Council. So you know you’ll get the high standard of care you’d expect.

3. If you’re referred for more treatment
Hopefully by now you’ll be starting to feel better. But if your specialist refers you for more treatment we haven’t already approved, let us know, so we can check it’s covered. In MyAviva you can submit your update or start a Live Chat to speak to someone in the claims team there and then. You can also call us, if you’d feel more comfortable talking over the phone, or email us with any questions you may have.

Remember! For some treatments and tests, we’ll ask you for a procedure code. So check with your specialist, and have it handy when you get in touch.

4. And finally, we’ll settle the bills
Once you’ve had the care you need, we’ll settle bills we’ve authorised directly with your provider – so you don’t have to worry.

We’ll let you know through MyAviva if you need to pay any part of a bill, like if you have an excess or benefit limit. If any bills are sent your way, just send us a copy and we’ll do the rest.

Here’s a quick recap of how to make a claim:
1. Ask your GP for an open referral – and get in touch with us before you have any tests or treatment. For BacktoBetter or Mental Health Pathway, just contact us direct.
2. Start your claim and book your appointment at an agreed hospital.
3. Let us know if you’re referred for more treatment – and check for a procedure code.
4. We’ll settle authorised bills direct, so you don’t have to worry.

And that’s it! Four easy steps, and a friendly claims team on hand for guidance and support each step of the way.
So you can focus on your treatment, and getting back to health.