What pre-authorisation is, exactly what your insurer asks for, how long it takes and what to do when authorisation is refused on a UK health insurance claim.
Pre-authorisation on a private health insurance claim
Pre-authorisation is the insurer's confirmation, before you are treated, that a claim is covered. Getting it right is the difference between a settled claim and a bill you pay yourself.
What the insurer asks for
- Your policy number and the member being treated.
- The GP referral, including the specialty and ideally a named consultant.
- Your symptoms, when they started and any related history.
- The proposed consultant, hospital and procedure code where known.
- Confirmation the condition is acute rather than chronic.
Why authorisation gets refused
| Reason | What to do |
|---|---|
| Pre-existing condition under moratorium | Ask for the specific symptom dates the insurer relied on and challenge if wrong |
| Condition classed as chronic | Request the clinical basis in writing; acute flare-ups of a chronic condition are often still covered |
| Consultant not recognised | Ask for a fee-assured alternative before booking |
| Hospital off-list | Switch to a listed hospital or accept a shortfall |
| Treatment excluded by policy wording | Ask which exclusion clause applies, by number |
Practical rules
- Never book treatment before you have an authorisation number.
- Get the authorisation reference and the name of the person who gave it.
- Ask explicitly whether consultant fees are covered in full or only to the fee schedule.
- Re-authorise if the treatment plan changes.
- Keep every reference number — it shortens any later dispute considerably.
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
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