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Your how to claim guide

Claims made easy

Are you unwell?

The first thing you should do is see your General Practitioner (GP).

Simply call us as soon as your GP refers you for private treatment. We can then make the necessary checks that the treatment is eligible before you incur any costs. Where possible, we will assess your claim over the phone, however we may need to ask for more details about your medical condition particularly if your policy excludes cover for treatment of pre existing conditions.

Sometimes we will need to contact your GP or specialist for more information before we can authorise a claim.

Alternatively, we may send you a form that you need to take to your GP to get completed. Please be aware: your GP may make a charge for providing information to us and this charge is not covered by the policy.

Be aware:

Your GP may make a charge for providing information to us and this charge is not covered by the policy.

Do you need to see a specialist, physiotherapist, complementary medicine practitioner or a clinical practitioner?

Before seeing the specialist, physiotherapist, complementary medicine practitioner or clinical practitioner you must call the claims line on 0800 0687111.

All treatment must be pre-authorised through the helpline as we do not want you to incur any charges that may not be covered. We will pay eligible fees in full when a specialist, physiotherapist, complementary practitioner or clinical practitioner charges up to the level within our published schedule of procedures and fees. Please see the 'who we pay for treatment' section of your Policy Booklet for full details.

The Directory of Hospitals lists the hospitals and day-patient units in the United Kingdom for which we provide cover. Please see 'where you are covered for treatment' section of your Policy Booklet for full details.

What will we check when you phone?

Although the exact requirements will depend on your individual circumstances, our Claims Team are likely to discuss the following with you:

• If you would like us to support you in identifying a suitable specialist, you can ask your GP for an 'open referral'. This means your GP makes a general referral by stating what treatment is necessary and the type of specialist you require that treatment from, but they do not specify the specialist's name. If your GP has referred you to a specific person for treatment we will check they are recognised by us for benefit.
• If you need hospital treatment we will discuss with you the cover available and which hospitals, day patient units and scanning centres are covered by your policy. Also if you are having a surgical procedure it would be helpful for us to know the procedure code so we can identify the exact treatment you will be having.

Your claim form

A claim form to be completed by you and your GP or specialist will be sent to you on the same day.

Completed claim forms

Please send your completed claim form (and any invoices) to:

PHC Claims
32 Church Street
Rickmansworth
Hertfordshire
WD3 1DJ

Settling accounts

All accounts will be settled directly. Should any accounts be sent direct to you please forward them immediately to the above address. Some hospitals may require you to pay for some services e.g. x-rays, blood tests etc, yourself. If this does happen please forward the receipted original invoices as above.

If at any time you require assistance call the claims help line on 0800 0687111.