Small-to-Medium Enterprise Private Health Insurance Claims
Making a claim
If one of your employees needs to make a claim, we have a dedicated claims team to look after them throughout the process.
We also have clinicians on hand to give our claims teams detailed support, providing medical insights as necessary to make sure your employees get the best support throughout their claim. Regardless of the complexity of the condition or the claim, your employees will have the right support when they need it.
We 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 and we'll aim to get a resolution for them as quickly as possible.
Expert Select, our core route to treatment
Our Expert Select hospital option is designed to help your employees find the most suitable specialist and hospital for their condition, giving them a range to choose from.
When an employee speaks to us, we'll offer them a choice of local hospitals. We base our recommendations on their diagnostic or treatment needs to make sure they get safe and effective treatment options every time. This gives employees an informed choice based on what's been recommended to them.
Making a claim with Expert Select
Step 1
If your employee is unwell, they'll need to see a GP where they may be referred for further assessment. They'll need to ask their GP for an open referral, specifying the type of specialist they need to see without naming one.
Step 2
When they have their open referral, they'll need to call us to set up their claim. We'll give them a choice of local medical facilities and consultants who meet our quality requirements.
Calls to and from Aviva may be monitored and/or recorded.
Step 3
We'll book an appointment for your employee at their chosen facility. In some cases the employee may be transferred to the booking team at their chosen facility to arrange an appointment.
Step 4
We'll settle all eligible bills with the approved provider so the member doesn't have to worry about any unexpected fees.
Additional support with Networks
Networks provide an even greater level of assurance - quality guiding for specific condition types such as cataracts or hip and knee conditions. We offer a network of treatment units who specialise in providing treatment for these specific conditions.
Providers in our networks are updated frequently as we work to get the best possible service for our customers. These networks allow us to offer greater assurance when it comes to clinical quality and treatment, and ensure that more treatment can be covered for the same cost.
To benefit from our networks, employees will need to obtain an open referral from their GP. This means that the GP specifies the required area of medicine (the speciality and sub-speciality), but not where you should go for treatment, or who you should see.
Making a claim through the BacktoBetter service couldn't be simpler.
If your employees ask you to explain how to claim through the BacktoBetter service, it's just four steps:
Step 1 - Make a call
To access BacktoBetter the employee should call the customer service helpline on 0800 158 3333 and describe their symptoms. This is an initial call so we can assess the claim.
Calls to and from Aviva may be monitored and/or recorded.
Step 2 - Clinical assessment
Our claims consultant will chat through your employees needs and ask them to complete an assessment over the phone or online through BacktoBetterDigital.
By going online, they can complete the assessment straightaway or book a tele-physio or face-to-face appointment.
Step 3 - Personal treatment plan
The third party case manager may provide a treatment plan that includes advice and online support on managing your employees symptoms and pain.
If clinically appropriate, they may be referred to a physiotherapist approved by the third party clinical case management provider for treatment and/or to a specialist for further treatment or diagnostic tests as necessary. The clinical case manager will also advise how best to remain active with a tailored home exercise programme and will continue to monitor their progress throughout the claim.
Step 4 - Paying the bills
At the end of the claim, we'll settle all eligible bills directly with the treatment provider, so your employee doesn't need to worry. If the policy has an out-patient limit, this won't apply to physiotherapy arranged through BacktoBetter.
Mental Health Pathway - making a claim
Your employees don't need to speak to their GP before making a claim.
Step 1
The employee should call our customer service helpline where one of our advisers will transfer them through to our independent third party clinical provider for an assessment or we can arrange a suitable call back time.
Step 2
Following the telephone assessment, the therapist will agree on the most appropriate help for the employee from a range of treatment options ranging from self-directed online support through to remote talking therapies, face-to-face treatment or further assessment by a psychiatrist, if clinically necessary.
Making a claim for all other conditions and hospital lists
Our documents are designed to help employees make a claim easily and the majority of cases can be approved over the phone.
Employees should always telephone our customer service helpline as detailed below, prior to receiving any treatment. We can then confirm that the hospital they've selected is recognised by us to provide the type of treatment they require and for the condition that requires treatment.
There is a 4 step claims process.
Step 1
If an employee is unwell they'll need to see a GP, where they may be referred for further assessment or treatment. This could be an open referral or a named referral. If they would like to use our networks, they will need to obtain an open referral enabling us to suggest treatment facilities and specialists for their condition.
It’s really important that employees get in touch with us before attending any further appointments so we can make sure their claim is covered under the terms and conditions of the policy before they incur any costs.
Step 2
When an employee has been given a referral by their GP, they need to call us to set up their claim. They should call the claims team on: 0800 158 3333
Monday to Friday: 8.00am to 6.30pm Saturday: 9.00am to 1.00pm
Calls to and from Aviva may be monitored and/or recorded.
If we have a network in place for the treatment recommended, we will offer suggestions where they can have their treatment. To benefit from our networks, they'll need to obtain an open referral.
If we don't have a network for the employee’s condition or suspected condition or the employee would rather be treated at a treatment facility on their chosen hospital list:
If the employee has been given a named referral, we’ll check to make sure the specialist is recognised by us, or
If it’s an open referral, we’ll use our specialist finder database to select an appropriate specialist and/or hospital.
Step 3
After the employee attends an appointment, their specialist may recommend hospital treatment – this is when they need to ask for a procedure code (CCSD code).
Once they’ve called us with these details, we'll confirm whether their treatment can be covered. If it can, we'll provide further information about where they can have their treatment, which may be through one of our networks, at a hospital on their hospital list or at other facilities recognised by us.
Step 4
Most eligible bills can be settled directly with the hospital. Specialists usually send their bills straight to us, but if you or the employee receives the paperwork, it will need to be forwarded to us at:
Bill Payment Team
Aviva Health UK
Unit 1A, Hampshire Corporate Park
Templars Way
Eastleigh
Hampshire
SO53 3RY
Alternatively, it can be emailed to HCTEAM1@aviva.com
We’ll do everything we can to make sure your employees get the support they need if they're injured or ill. That includes being empathetic with their situation when they call to make a claim. Our teams are trained to understand that people may not be feeling well – and do their best to make it a stress-free process.
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 eligible under the policy, we'll explain to them why it's not covered.
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