How to make a claim

You can submit a claim online 24 hours a day, 7 days a week. It’s secure, will only take a few minutes and we’ll aim to get back to you by midday on the next working day. Your claim will be assessed by one of our claims assessors who have on average, six years’ experience looking after our members. They’ll guide you through the next steps so, you don’t have to worry about your cover – instead, you can focus on getting better. Follow our four simple steps to making a claim.

Step 1: Get a referral from your GP

Firstly, visit your GP. If you're unwell, the first thing to do is to visit your GP. If they refer you for treatment, tell them you have cover with PruHealth and ask for the following:

  • Full details of your condition/injury, diagnosis and intended treatment.
  • Full name and address of the specialist or therapist and the hospital/clinic you've been referred to.

 

Need physio?

If you've been referred for physiotherapy, we have a network of approved physiotherapists we can recommend. Ask us for more information when you call, or if you fill in the details of your claim online, we can arrange for them to call you back to make an appointment.

 

Any claims that you do need to make, may result in your no-claims discounts being decreased in the next plan year. If you do feel unwell, please do not delay seeking treatment because of the impact it will have on your no-claims discount.

Step 2: Get your claim approved

Once you’ve got a referral you’ll need to register your claim and check you’re covered. You can make a claim online 24 hours a day, 7 days a week on the Member Zone. It’s secure, will only take a few minutes and we’ll aim to get back to you by midday on the next working day. Once your claim’s approved we’ll send you an authorisation letter. You should take this letter to your appointment to show you’re covered.

 

You can also register your claim by calling us on the number on your membership card.

 

When you call, select the option to 'get authorisation for treatment' so that you go through to our dedicated Claims Team. Make sure you have your membership number on hand when you call. Our Claims Team is available Monday-Friday 8am to 8pm and Saturday 8am to 1pm. Please note our offices will be closed on bank holidays.


Don't have your card on hand? Is your cover through your or your partner's employer?

  • Yes, Call us on 0800 028 5777
  • No, Call us on 0800 092 7333

You might be asked to give details of your condition over the phone, so you may want to make the call in private. You may also be asked to have your GP, specialist or therapist complete a medical report. This will help us to confirm that you are covered for your treatment.

Step 3: Book your appointment

Book your appointment. Once we've confirmed you're covered for your treatment you can book your appointment with the specialist. Once you have confirmed your appointment we will give you an authorisation number. We will also send you confirmation of your details by post or email, including your authorisation number and any limits that may apply on your cover.

 

Remember to take the authorisation number with you when you visit your specialist. You should also take a copy of your hospital list so your specialist can see which hospitals you are covered at for treatment.

 

For a full list of the hospitals you have access to, visit the 'My hospitals' tab when you log in to the Member Zone.

 

Need further treatment? Contact us first

If you do need further treatment your specialist should give you a procedure code, along with the date and place of treatment. Then contact us, either by submitting a continuation claim online or calling us to make sure you’re fully covered for further treatment. Otherwise you may need to pay for the treatment yourself.

Step 4: Leave us to pay the bill

In most cases we’ll settle your bills direct with the healthcare provider. This means you can focus on getting better. If you have an excess on your plan you’ll have to pay this directly to your provider and we’ll let you know exactly when you need to pay this.

If you do make a payment yourself send us the proof of payment to the address below and we’ll pay you back. Please remember that we will only cover medical expenses - any personal expenses, such as newspapers, visitors' meals etc will need to be settled by you.

Post:  PruHealth Customer Services, Stirling, FK9 4UE,
Email:authorisations@pruhealth.co.uk
Fax: 0800 015 8700

 

 

We'll add a claims statement to your Member Zone showing the amounts we've paid and whether there is any excess or co-payment you still need to pay.


Your hospitals

For a full list of the hospitals you have access to, visit the 'My hospitals' tab when you log in to the Member Zone.

Call us if you have any questions, or need any additional help.

Making a claim by phone

Covered as an employee?

Call us on 0800 028 5777

Covered as an individual?

Call us on 0800 092 7333

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