Private health insurance

Making a claim

If your employees need to make a claim, then we'll do everything we can to make things go smoothly. We understand that they may not be feeling 100% when they call. Most claims can be approved over the phone, with no need for paperwork at all.

Our claims follow two different paths depending on what type of condition your employees are claiming for. Don't worry though, they're both really easy to follow and only have small differences.

BacktoBetter Claims

If you employees are claiming for pain in their back, neck, muscles or joints then they need to use our innovative BacktoBetter musculoskeletal clinical case management service.

These claims follow a simple three step process and they don't need to see their GP:

Step 1 - The employee just needs to call our customer service helpline to describe their symptoms - remember they don't need to see their GP before calling us.

Step 2 - Providing it’s a valid claim, our advisers will arrange for a case manager from one of our clinical providers to contact the employee to assess their symptoms - we always aim to have the assessment at a convenient time.

Step 3 - The clinical case manager will determine whether a referral for treatment is necessary. If treatment is not necessary, the employee will be taught how to self manage their condition.

If treatment is recommended they'll be referred to an approved physiotherapist from our quality assured network (to be seen within 2 working days), or they'll be referred to a specialist for diagnostics and/or treatment.

Standard claims

For all other claims (so for any condition other than pain in the back, neck, muscles or joints) it's also a simple three step process. If your employees are unsure what to do when they come to claim they can call our customer service helpline and we'll explain what needs to happen at each stage.

Step 1 - When a specialist's opinion and diagnosis is needed, the GP must make a referral to a specialist working at or from a hospital on your company's chosen list.

Step 2 - As soon as a referral has been made, your employee should call us.

Step 3 - We'll do our best to assess the claim and authorise it over the phone, if possible. If we need more information, then we'll send out a claim form. We'll also help your employee complete it.

Whatever route your employees' claim has taken, as soon as treatment has finished, we'll settle all eligible bills directly with the hospital.

Over 84% of our claims are approved over the phone

If we need more information, we'll do our best to make sure that paperwork doesn't hold things up. If we can't approve your employee's claim because it's not covered by your policy, we'll explain the details to you - though we won't divulge any confidential medical details.

MyHealthClaim app

Don't forget that your employees can use the MyHealthClaim app to find a specialist and discuss their options whilst they’re with their GP, making things easier for everybody.

We're here to help you

We have claims teams that have received in depth training. For example, our oncology claims department is trained to deal with the circumstances surrounding a claim for cancer treatment. And our psychiatric team understands that dealing with an insurance claim may be difficult at this time.

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