How to claim
Our guide to making a claim and what to expect.
This page can help to guide you through the typical steps of making a claim and what to expect.
If you have any questions:
Please call the Claims Helpline on 0208 410 0440^ between 8am and 6pm Monday to Friday (excluding bank holidays), or email us at claims@cshealthcare.co.uk
Members must contact us to obtain pre-authorisation before proceeding with any appointments or treatments. Failure to obtain pre-authorisation in advance of treatment may result in benefits being declined and invoices for treatment costs being returned unpaid.
Here’s our guide to making a claim and what you can expect.
1. Pre-authorisation
When you call us for pre-authorisation, please have the following information to hand:
- Your registration number
- A GP referral
- The name of the specialist you will be seeing
- The hospital you’ll be attending
- The date of your appointment or treatment
- Details about your condition
Call us on 0208 410 0440^ or email claims@cshealthcare.co.uk
You can also download our pre-authorisation form
2. Seeing a specialist
If you need to see a specialist and have been referred by your GP we can usually pre-authorise this for you over the phone so long as you give us the following information:
- The name of the specialist you will be seeing
- The hospital you’ll be attending
- The date of your appointment
- Details about your condition
If you have a Moratorium policy, or a fully medically underwritten policy that has been in place for less than 12 months, we’ll need you to provide a copy of your GP referral letter so we can assess your claim before we can provide a pre-authorisation.
3. Investigations
Once you’ve seen a specialist they may recommend investigations or tests to help diagnose your condition and decide on a treatment plan.
If this happens, you’ll need to ask them whether the particular test has a CCSD code*. You’ll then need to contact the Claims Helpline with details of the proposed test, including this CCSD code, so we can see if it is covered.
If you are going to see your specialist for a follow-up consultation after an investigation, we recommend you take a copy of the pre-authorisation request form (PDF, 0.5MB) to the consultation (See ‘Post diagnosis treatment’).
4. Post diagnosis treatment
To allow us to provide a pre-authorisation for planned surgery, your specialist will need to complete a pre-authorisation request form and send it to us for assessment.
Download our pre-authorisation request form (PDF, 0.5MB) (This form is not required for initial consultations).
For the following conditions and/or treatments, a clinic letter and investigation results will be needed along with the completed pre-authorisation request form:
- Joint replacements
- Skin conditions requiring surgery (including biopsies and/or therapeutic treatments)
- Cardiac procedures (e.g. coronary angiography +/- angioplasty, bypass, valve replacements, pacemaker etc.)
- Spinal surgeries
- Psychiatric treatment
- Cancer treatment
Pre-authorisation requests for the following types of treatment can usually be assessed over the phone without a completed pre-authorisation request form:
- Initial and/or follow up consultations (excluding psychiatric)
- Cataract surgery
- Tests and investigations (including CT and MRI)
- Endoscopies (excluding laparoscopy)
- Knee arthroscopies
- Initial steroid injections (into joints)
Please complete the pre-authorisation request form for non-steroid injections (into joints).
Members should contact the Claims Helpline on 020 8410 0440^ for pre-authorisation.
Once the specialist has completed your pre-authorisation request form please send it to us by
Email: claims@cshealthcare.co.uk
Post: Bupa, Princess House, 1 Horace Rd, Kingston upon Thames KT1 2SL.
In some cases we may need more information from your specialist to assess whether the treatment is covered by your policy.
5. Additional information
When we assess a pre-authorisation request for cover, a number of factors will determine the level of cover that will be available to you. In this section we explain what some of those terms mean and how they may affect your claim.
*CCSD code
Each surgical or medical procedure and many diagnostic tests have their own CCSD code and description, which are used as a common term of reference within private healthcare. The CCSD code is typically a combination of numbers and letters, for example: W4212 Minimally invasive knee replacement.
The CCSD code means we know exactly which procedure or test that your specialist is proposing and helps us understand the complexity of it and the expected length of any stay in hospital after surgery.
Fee Schedule (Customary and reasonable)
If you need to claim for a surgical or medical procedure or diagnostic test which has a CCSD code, your policy can contribute towards the fees charged by the specialist providing your treatment.
You can find out how much you policy covers you for by calling the Claims Helpline on 0208 410 0440^ between 8am and 6pm Monday to Friday. Please have the CCSD code(s) provided by your specialist and/or anaesthetist available when you call us.
We strongly recommend you discuss our Fee Schedule with your consultant and/or anaesthetist before starting pre-authorised treatment so you are aware of any shortfalls that may arise. Providers do not need to call the helpline, they can refer to Bupa’s schedule of procedures.
If you have any questions
Please call the Claims Helpline on 0208 410 0440^ between 8am and 6pm Monday to Friday (excluding public holidays), or email us at claims@cshealthcare.co.uk
Members need to contact us for pre-authorisation before going ahead with any appointments or treatment(s). Benefits may be declined and invoices for appointments and treatment may be returned unpaid if pre-authorisation is not obtained in advance.
^Lines are open Monday to Friday 8am to 6pm, excluding bank holidays. We may record or monitor our calls.
We recognise that when you give us personal information (which includes health information) you’re trusting us to take good care of it. Please see our privacy notice for more information about how we collect, use and protect your data.
Bupa health insurance is provided by Bupa Insurance Limited. Registered in England and Wales No. 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 No. 3829851. Registered office: 1 Angel Court, London, EC2R 7HJ.
