Quick Answer
- What it is:
- Private Medical Insurance Claim — a health procedure in United Kingdom.
- Deadline:
- 90 days
- Steps:
- 5 steps
- Cost:
- Free
- Documents:
- 4 required
- Legal basis:
- Insurance Act 2015 s.13A
Miss the deadline? Insurer may decline late claims at their discretion
Important Deadlines
Submit claim within 90 days of treatment
Insurer may decline late claims at their discretion
Insurer must issue a final response within 8 weeks
Right to escalate to FOS without final response
Refer to FOS within 6 months of final response
FOS jurisdiction is barred
Required Documents
- ✓Itemised invoice with CCSD/OPCS-4 procedure codes
- ✓Consultant's letter / clinical summary
- ✓Pre-authorisation reference (where required)
- ✓Policy schedule and certificate
Step-by-Step Guide
Obtain pre-authorisation BEFORE treatment for in-patient stays, MRI/CT scans, and specialist consultations.
Pro tip: BUPA, AXA Health and Vitality all require pre-auth. Without it, claims are routinely declined.
After treatment, request a fully-itemised invoice from the hospital/consultant including procedure codes (CCSD or OPCS-4).
Pro tip: A 'consultation' line without a procedure code is the #1 reason claims are paid below tariff.
Submit the claim within 90 days of treatment via insurer app, web portal, or email PDF.
Pro tip: After 90 days, insurers can decline at their discretion — even with a valid claim.
If declined, request a final response and complaint reference within 8 weeks (FCA DISP rules).
Pro tip: The final response letter unlocks the FOS escalation route — request it explicitly.
Escalate to the Financial Ombudsman Service (FOS) within 6 months of the final response.
Pro tip: FOS is free and binding on insurers up to £445,000 (Apr 2024 onwards).
Fees
Legal Basis
Also Known As
This procedure is commonly searched under these names:
Official Resources
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