Health insurance claim problems, can your broker help?

When you want to make a claim on your health insurance policy you do not want to have to deal with issues relating to cover.  If you are having health insurance claim problems then your broker should be able to step up and help you.

At SMP Healthcare we can help you make sure your valid claims are not declined.

Sometimes this happens through misinformation or lack of detailed clarification from GP and specialists. It is honestly not the insurance company being deliberately uncooperative. We are ready to help you resolve any insurance claim problems with your insurer.

A real life example of how we helped a client to resolve their Insurance Claim Problems

As an example this week we have assisted a client who called for pre-authorisation but the claim was declined.

  • The symptoms he had were similar to common condition that is deemed as chronic and therefore excluded from cover under the general terms of the policy.
  • However, the clients GP was fairly convinced this was not related to the condition the insurer was referring to.
  • Our client called us and we explained the insurance company’s reasons but confirmed that they would re-evaluate the claim if the GP would write a letter explaining why they thought these symptoms were un-related.
  • A letter was sent to the claims team for re-evaluation but they still declined the claim as there was insufficient detail.
  • Our client by this time was fairly despondent and getting worried.
  • The GP was suggesting various diagnostic tests some of which would be costly.
  • With long waiting lists on the NHS is the clients area, we suggested he pay for a private consultation and see what the specialists opinion of his condition was.

After the consultation, the client emailed us with a copy of the referral letter from the specialist. The consultant had provided full, clear and unquestionable data about the clients’ condition, what tests were needed and why the symptoms did not point to chronic condition. We therefore called the insurer again and explained the scenario.

The original health insurance claim decision was reversed:

The claims manager re-assessed the claims declinature and reversed the decision. They agreed for all the necessary diagnostic tests. They also agreed to retrospectively pay for the initial consultation too upon receipt of the invoice from the specialist that the client had paid.

By working with us and trusting our judgement, our client’s valid claim has been authorised. He has not even had the hassle of dealing with the claims team directly. We have done this for him because of the problems he experienced. For the sake of just a few phone calls and thinking outside of the box we have a happy client. He is now on route to diagnosis without having to self-fund any of the treatment at all.

As a specialist private medical insurance broker we will work with you every step of the way. We will always help you when you are experiencing insurance claim problems. There is no guarantee that every decision can be changed. If your claim is not eligible under the terms of your policy this is not something we can alter. However, if it is a case of misunderstanding or un-clarified information then we will do everything in our power to make sure you get a positive outcome.

If you would like to know how we can help you with your Health Insurance, please get in touch:

Telephone 01245 929129/ 0800 047 0127  or email