Do you always need a GP referral if you want to make a claim on your PMI policy?


If you have a Private Medical Insurance policy and you need to make a claim, you are normally required to see your GP first. However, depending on the insurer you are with and the underwriting you have in place, there are some conditions where a GP referral is not required.

How is this possible?

Some insurers have designed direct access pathways for a number of services, eliminating the need for a GP referral, meaning you can get the treatment you need as soon as you decide you need it. Depending on the insurer and underwriting, you may be able to access some of the following services without the need to see your GP first about conditions that affect:

– Muscle, joints or bones

– Mental Health

–  Eyes

Examples of some of the direct access pathways offered by insurers

AVIVA’s BacktoBetter service provides members on part of a group scheme to access a clinical case manager whenever they get back, neck, muscle or joint pain (musculoskeletal conditions).

Bupa’s Mental Health Specialist Support service, provides Bupa health insurance members with fast and convenient access to mental health support and treatment via their telephone assessment service usually without the need for a GP referral.

Vitality Health’s Priority Physio service, provides members with an efficient end-to-end physiotherapy service with a self-referral process, so no need for a GP or consultant referral.

AXA PPP Healthcare’s Working Body service, provides members access to advice and treatment for muscle, bone and joint pain without the need for a GP referral.

Important things to note

Insurers which offer direct access pathways to their members will have specific rules and terms around who can access them and how, therefore it is always worth checking the terms and conditions of your policy. SMP Healthcare Ltd can help you check your policy details and can also advise about the direct access pathways your policy offers. Simply contact us on 01245 929 129 or email and we will be happy to help you.