Your treatment
- I think I need treatment what do I do?
- What is pre-authorisation?
- What information will I need to pre-authorise treatment?
- What kind of treatment is covered?
- What is not covered in my treatment?
- Are there limits to the level of cover provided?
- Why does BUPA only recognise particular hospitals and consultants?
- How do I know whether the consultant or specialist my GP recommends is approved by BUPA?
- What if I would like some advice about the treatment itself?
- I require urgent medical treatment, what should I do?
- I am unsure if I am eligible to claim. What should I do?
- How do I know what my benefit entitlement is?
I think I need treatment what do I do?
Make an appointment with your GP and if you do need treatment, ask him/her to refer you to a BUPA recognised practitioner/BUPA network hospital.
What is pre-authorisation?
It is important you call BUPA before you proceed with any treatment in order for us to pre-authorise it. Pre-authorisation means that we make sure all aspects of your treatment are eligible under the terms of the scheme you have, for example your condition, the consultant carrying out the treatment, the hospital where you are treated and the monetary amounts you are entitled to under your scheme.
After your initial consultation, you may need to contact us again with details of any treatment recommended by your consultant. With these details we can again let you know about your benefits before further costs are incurred, to ensure there are no unexpected personal costs.
What information will I need to pre-authorise treatment?
In order to process your claim as quickly as possible it helps to have the following items to hand when you call us for pre authorisation:
- the name of the consultant or therapist
- the name of the anaesthetist (if this is applicable and you know it)
- the name of the hospital in which the treatment is to take place
- details of your condition or symptoms
- the date of your appointment or treatment
- the type of treatment you will be having if this is known
What kind of treatment is covered?
Cover is provided for treatment of most types of acute medical conditions when recommended by your GP. An acute condition is a disease, illness or injury that is likely to respond quickly to treatment, which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads you to full recovery. The scheme does not cover chronic conditions (i.e. those which are long term or permanent, likely to keep recurring or for which there is no known cure), or exclusions such as pregnancy-related treatments, routine dentistry, renal dialysis etc. Before arranging any treatment, please contact us and one of the member service advisers will be happy to advise whether it will be covered.
What is not covered in my treatment?
A full list of those treatments you are not covered for is in your Membership Guide. Please refer to your Membership Guide or contact us for guidance on benefit limits.
Are there limits to the level of cover provided?
Yes. For example, on most schemes outpatient treatment benefit limits are applied. Please refer to your Membership Guide or contact us to confirm the outpatient limit on your scheme. Other treatment, such as CT/MRI scans, day-patient and in-patient treatment, surgical operations, anaesthetists' fees, will normally be paid in full if provided by a BUPA partnership consultant in a BUPA network hospital. Treatment provided by a consultant who is not a BUPA partnership consultant, but who is recognised by BUPA and charges within BUPA's standard fee limits will normally also be fully covered. Please contact us for guidance on benefit limits.
Why does BUPA only recognise particular hospitals and consultants?
To gain approved status, hospitals and consultants are assessed individually and must fulfil certain standards set by BUPA. These standards have been developed by a dedicated BUPA team working with recognised professionals. Because of this, the standards are based on best practice standards and guidelines used by professional bodies involved in health care and the NHS.
How do I know whether the consultant or specialist my GP recommends is approved by BUPA?
When you see your GP, please make sure he/she knows that your private medical cover is being provided by BUPA and ask him/her to refer you to a BUPA-recognised practitioner. The vast majority of consultants are either BUPA partnership consultants or BUPA recognised. Please be aware that there are still some consultants who charge fees in excess of your scheme benefit limits and while they may be BUPA recognised to carry out the treatment, their fees will only be reimbursed up to your scheme benefit limit. To be sure your treatment will be covered in full, please contact us and the member services adviser will check whether your consultant will be paid in full.
What if I would like some advice about the treatment itself?
Contact us and ask to be put through to one of the nurses on the care management team who will be pleased to help.
I require urgent medical treatment, what should I do?
Seek medical advice from your GP, but if you need urgent treatment you can also go to a walk in centre or A&E if appropriate.
I am unsure if I am eligible to claim. What should I do?
Refer to your Membership Guide to see what's not covered, and if you are still unsure then contact us.
How do I know what my benefit entitlement is?
Refer to your Membership Guide and if you are still unsure then contact us.