Guide to making a health insurance claim
Do your symptoms fall into any of these categories?
If you’re experiencing any of these symptoms and you have Direct Access, call us directly. We’ll check that your symptoms are covered and explain how you can get help. You may be able to get treatment without a GP referral.
If your issue is with something else, visit our ‘Get treatment’ page to see how to get help.
If your symptoms aren’t listed above, follow our step by step guide:
Step 1:
See a GP
If your symptoms aren’t covered by our Direct Access service, you should speak to a GP first.
Book an appointment with your own GP or through a digital GP service. They can advise you if you need to see a specialist or healthcare professional.
Speak to a GP from anywhere
With our digital GP services, you can get professional advice at a time that suits you.
Health advice day or night
With our Anytime HealthLine, you can get health advice from a nurse at any time of the night or day..
Step 2:
Ask the GP for an open referral
If you have a condition that requires a GP referral, we recommend you ask for an ‘Open Referral letter’. This will detail the care your GP would like you to have, but will not be addressed to a specific consultant, hospital, or healthcare professional.
The referral needs to include the type of speciality that you have been referred to.
We aim to offer a choice of two or three specialists. If the first-choice specialist is unavailable, you can see someone else without having to return to your GP for a second referral.
You can also choose to speak to a specialist over the phone or by video. You can call us on 0345 609 0111 to discuss your options. Lines are open 8am - 8pm Monday to Friday, 8am-4pm Saturdays. We may record or monitor phone calls.
Important: Open Referral is mandatory on some personal, corporate and company schemes. If you need help, please call us on 0345 609 0444. Lines are open Monday to Friday 8am to 8pm and Saturday 9am to 12.30pm. We may record or monitor phone calls.
Step 3:
Contact us for a pre-authorisation code
As soon as you’ve seen your GP please contact us. We’ll discuss your options and explain what you’re covered for. Our advisor will talk you through what you need to do next and will send any pre-treatment forms that you need to complete.
If you’re covered we will give you a pre-authorisation code. You’ll show this to your specialist. It lets them know that Bupa has approved your treatment.
Here's what you'll need when you contact us:
- Your Bupa membership number
- Details of when your symptoms first began
- Details of when you first consulted your GP about your symptoms
- The symptoms you're suffering from
- Details of the treatment your GP has recommended
Speak to one of our advisors today
0345 609 0111
Lines are open 8am - 8pm Monday to Friday, 8am - 4pm Saturdays. We may record or monitor our phone calls.
Got a referral and need help finding a consultant?
Use Finder, our online directory of hospitals and consultants. Search for the right service for you, in your local area.
What happens next?
See your pre-authorisation in My Bupa
If you've been referred to see a healthcare specialist, it’s important to talk to us so we can check that your treatment is covered. Once we have established that it is, we'll give you a pre-authorisation code.
If you already have an approved pre-authorisation, you can view the details in the My Bupa app.
Sign in with your Bupa account details or create a digital account.
Scan the QR code with your phone camera to download the app.
Medical Reports
We may need to ask your doctor for more information about your consultations, tests or treatment. If this is the case, we’ll need your permission to see your medical reports.
Invoicing
If you are sent an invoice, simply send it to:
Bupa Place, 102 The Quays,
Salford, M50 3SP
Health insurance covers conditions that develop after your cover starts.
When you claim, we may need some more information from you and your healthcare practitioner to check when your symptoms or condition started.
This helps us be clear about what you’re covered for and deliver a fair claims experience for you and all our customers.
We don’t always need medical information from you when you claim. If we do, we’ll send you a form to complete with information about your condition, symptoms and reasons for seeking medical advice.
You will need to ask a healthcare practitioner, usually your GP, to complete information about your medical history.
You might not need to fill out any forms. Our claims department can explain whether you need to complete any forms, and they can help you if you have questions.
If you do need to fill out a form, your healthcare practitioner may charge you for completing this.
Depending on the type of underwriting you’ve chosen and the terms and conditions of your cover, we may contribute £50, including VAT, towards the cost of this.
We’ll let you know about any costs you may need to pay when we send you the form.
You can start treatment, but we won’t be able to confirm if it’s covered until we’ve received the form. If it’s not covered, you’ll have to pay for the treatment yourself.
Bupa health insurance is provided by Bupa Insurance Limited. Registered in England and Wales with registration number 3956433. Bupa Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Arranged and administered by Bupa Insurance Services Limited, which is authorised and regulated by the Financial Conduct Authority. Registered in England and Wales with registration number 3829851. Registered office: 1 Angel Court, London, EC2R 7HJ.
Anytime HealthLine is provided by Bupa Occupational Health Limited. Registered in England and Wales No. 631336. Registered office: 1 Angel Court, London, EC2R 7HJ. Anytime HealthLine is not regulated by the Financial Conduct Authority.
