How to claim on UK private medical insurance: pre-authorisation, referrals, shortfalls, chronic-condition disputes and escalating to the Financial Ombudsman.
Health insurance claims helper
A practical walkthrough of claiming on a UK private medical insurance policy — what to do first, what insurers ask for, and what to do when a claim is declined or short-paid.
The claim sequence
| Step | What happens | What to watch |
|---|---|---|
| 1. GP or digital GP | You get a referral naming a specialty, and ideally a consultant | An open referral gives the insurer more control over who you see |
| 2. Pre-authorisation | You call the insurer before treatment and get a claim number | Treatment booked before authorisation can be declined |
| 3. Consultation and diagnostics | Consultant confirms diagnosis and treatment plan | Check the consultant is fee-assured on your policy |
| 4. Treatment authorisation | Insurer authorises the specific procedure and hospital | Confirm the hospital is on your list |
| 5. Settlement | Insurer pays the hospital and consultant directly | Check for shortfalls on consultant fees |
The four things that most often go wrong
- Treatment started before pre-authorisation was granted.
- A consultant charging above the insurer's fee schedule, creating a shortfall.
- The condition being reclassified as chronic, so ongoing cover stops.
- A pre-existing condition caught by the moratorium period.
How PremierPMI helps at claim
Claims advocacy is included for clients placed through us at no additional cost. We challenge shortfalls, push back on pre-authorisation refusals, request the insurer's reasoning in writing and, where it is warranted, take the case to a formal complaint and on to the Financial Ombudsman Service.
PremierPMI is a UK private medical insurance broker specialising in whole-of-market placement across 10+ leading UK health insurers including Bupa, AXA Health, Aviva, Vitality, WPA, Freedom Health, The Exeter, General & Medical and National Friendly. FCA regulated (Tesha Family Ltd, FRN 1029667). Speak to a broker on 020 4525 0884, WhatsApp 020 8064 2273, or email contact@premierpmi.co.uk.
Talk through your cover with a specialist PMI broker
PremierPMI's brokers are available Monday to Friday 9am to 5:30pm. Call 020 4525 0884, message us on WhatsApp 020 8064 2273, or email contact@premierpmi.co.uk. You can also request a callback or meet our team.