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 your employees are claiming for pain in their back, neck, muscles or joints (musculoskeletal conditions) then they can use the BacktoBetter 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 the clinical providers to contact the employee to assess their symptoms - we always aim to have the assessment take place 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 the case management providers' quality assured networks (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 - If an employee is unwell they will 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.

It’s really important that employees get in touch with us before attending any 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 referred by their GP they’ll need to call us to set up their claim.

If we have a network for the treatment the employee needs, we'll let them know where they can have their treatment. Our network facilities may be different to the hospitals on your chosen hospital list. If you have chosen the extended hospital list, your employees do not have to use our networks.

If we do not have a network for the employee’s condition or suspected condition:

  • if the employee has been given a named referral, we’ll check to make sure the specialist is recognised by us.
  • 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 where they need to ask for a procedure code (CCSD code).

Once they’ve called us with these details, we can confirm whether or not their treatment is covered and provide information about where they can receive treatment whether this is through our networks, at a hospital on your list or at other facilities recognised by us.

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.

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 mental health team understands that dealing with an insurance claim may be difficult at this time.

What is a network?

We’re developing a number of networks of facilities, specialists or other practitioners that we recognise to provide the treatment required for a specific condition or suspected condition.

By creating networks, Aviva has more control over the treatment pathway. This means we can drive better commercial deals, which helps us maintain affordable prices. What’s more, by controlling the treatment pathway we can give our customers greater assurance when it comes to clinical quality and treatment, and ensure that more treatment can be covered before benefits limits are reached.

Our networks are updated frequently as we work to ensure we get the best possible service for our customers. We regularly add or evolve networks, or in the event that a facility/specialist is no longer suitable for a network we may remove them. Please contact our claims team before arranging any treatment.

Contact our claims team on 0800 158 3344. Our lines are open from 8am-8pm Monday to Friday and 8am-1pm on Saturdays.


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