Health claims

Hospital treatment: what to do and what to gather

Check your cover before you go in, and keep every account and form.

Do this first

1. Check what your policy covers before planned treatment Ask your fund about waiting periods, your excess and whether the procedure is covered at that hospital.
2. Ask your doctor and the hospital for a written estimate of costs Including any gap you'd pay. Ask before the treatment, not after.
3. Complete the admission and claim forms the hospital gives you Most hospitals claim directly from your fund. Read what you sign.
4. Keep every account, receipt and discharge paper You'll want them if there's a gap payment or a query.

Who to tell

• Your health fund: Confirm cover and any pre-approval before planned treatment. For emergencies, tell them as soon as you can.
• Your GP, if a referral is needed: A referral from your GP or specialist may be needed for the treatment to be covered.

What to gather

• Your membership number and the policy you hold. The hospital and fund both ask for it.
• A written estimate of costs and the gap, if planned. Helps you avoid surprises.
• Itemised accounts from the hospital, surgeon and anaesthetist. Each provider usually bills separately.
• Proof of anything you paid. Shows your out-of-pocket costs.
• Referral letter, if required. Some treatment is only covered with one.
• Discharge summary. Records what was done.

Things that catch people out

• Waiting periods and exclusions are the most common reasons a claim isn't paid. Check them before treatment.
• Your excess and any gap payments come out of your pocket. Ask for the gap amount in writing beforehand.

General guidance only. It isn't your insurer's requirements or financial advice. Always check your policy documents and your insurer's instructions.