Making claims simple
The more employees you have working for you, the more likely it is that one of them will need to make a claim. We’ll do everything we can to make things go smoothly, because we know how important a professional and efficient service can be.
First and foremost, we want your employees to receive the levels of service they'll expect from a company like Aviva. We also know that your staff may not be feeling 100% when they call, so we’ll take great care to make sure they receive a sensitive, personal service – every step of the way.
Existing customers: Please refer to your member documentation for contact details to discuss your policy or to make a claim.
Step-by-step help from experts
From their initial GP's recommendations through to specialist referrals, we'll help individuals throughout their claim, explaining what needs to happen next. Claims can either be started online via MyAviva or over the telephone. If employees start their claim online, they can request a call back at a time to suit them. The claims consultant will access their details to help assess their claim and if a claim form is needed, they'll explain who needs to complete it. And of course, we'll settle all eligible invoices with the hospital on their behalf, once treatment is complete.
But an efficient claims service does more than help your employees – it also helps us identify and manage high-cost cases: things like cardiac or orthopaedic treatments or specific, more complex conditions such as cancer, stroke or mental health. This vigilance helps us to manage our premium levels for the long term, which is good news for everyone.
How to make a 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.
With our specialist claims teams, we can provide appropriate support to employees – and effectively manage costs.
How our BacktoBetter service works
What is BacktoBetter?
If you have aches or pains in your back, neck, muscles or joints – known as musculoskeletal conditions – you’re not alone.
As many as one in four UK adults are affected by these conditions. The pain, stiffness and limited movement they cause can have a real impact on your quality of life, and the things that matter most.
But it doesn’t have to be that way. When you have BacktoBetter on your Health policy or scheme, it’s easy to get the expert treatment you need. Which could help you get better, quicker.
How does BacktoBetter work?
With BacktoBetter, whenever you have back, neck, muscle or joint pain, you won’t need to see your GP for a referral. Simply contact our claims team by phone, or through MyAviva, if available on your scheme, to get your claim moving.
To kick things off, our claims team will discuss your symptoms with you. Then, if you’re eligible, they’ll arrange a call with a clinical case manager for a more in-depth assessment, at a time that works for you – which could be there and then.
Your treatment starts now!
Your case manager will ask a few key questions about how your symptoms are affecting your daily activities, and will have the expertise to recommend the right treatment for you. They’ll offer advice about how to manage any pain, and explain the best next steps…
Which might be:
A guided treatment plan
That’s advice specific to you and your condition, and easy-to-follow, prescribed home exercises. And with extra online support, you’ll have the tools to help you get back to health.
Your case manager will set up an virtual or clinic-based appointment with a physiotherapist. You can rest assured that all physiotherapists under the BacktoBetter pathway meet the standards of proficiency set by the Health and Care Professions Council.
Your physiotherapist may also recommend simple exercises to help with movement and improve strength, until your first session. And don’t worry if you have an outpatient limit, it won’t apply to physiotherapy.
Along the way, your case manager or Physiotherapist will talk to you about your ongoing treatment. That might include a referral for diagnostic tests and further treatment with a specialist or other health practitioner.
Because we won’t rest until we’ve done all we can to get you back to feeling like yourself again.
For full details of cover including restrictions and exclusions, please refer to the terms and conditions documents.
Want to talk to someone about Optimum? Speak to our dedicated national accounts team on:
Monday to Friday 9:00 to 17:00
Calls to and from Aviva may be monitored and/or recorded.