Do you need a GP referral to make a health insurance claim?

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, there are some conditions where a GP referral is not required and you can call your provider directly to make your health insurance claim.

What types of condition may not require a GP referral when you make a Health Insurance Claim

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

With modern technology improving, there are more options available for virtual or remote GP appointments too. All of these options make it easier when you need to make a health insurance claim.

Examples of some of the direct access pathways offered by insurers for Health Insurance Claims

Aviva’s BacktoBetter service provides access to a clinical case manager whenever you get back, neck, muscle or joint pain.  Theses are referred to as musculoskeletal conditions.

Bupa’s Mental Health Specialist Support service, provides Bupa health 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. Bupa also provide direct access for people who believe they are experiencing symptoms of cancer.

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

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

Important things to note about direct access for claims

Insurers that offer direct access pathways to their members will have specific rules and terms around how they are accessed. 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. We can help our clients who want to make a health insurance claim by explaining the options available.

Simply contact us on 01245 929 129 or email and we will be happy to help you.