Referral, authorisation, treatment, then the insurer pays the hospital directly — and the order matters more than any other part of it.

What the policy documents actually say

It usually starts with a GP referral to a named specialist, though not always. Bupa's Direct Access lets members phone about cancer, muscles, bones and joints, or mental health without one, and that assessment carries no excess and does not consume the out-patient allowance.

Then authorisation. You contact the insurer with the referral, the proposed consultant and the hospital, and it confirms whether all three are covered and the fees are within its schedule. This is the step that decides the claim. AXA Health also requires you to tell the hospital you are a member, so it charges the agreed rates rather than its own.

Treatment happens, and the hospital and consultant invoice the insurer directly. You rarely pay and reclaim. Where an excess applies, the insurer deducts it and tells you what to pay the provider — Bupa's own example has the member paying £100 straight to the physiotherapist.

Freedom Private Health Insurance describes the mechanic slightly differently: the excess comes off the first valid invoice and any subsequent ones until used up, with the member settling that portion with the provider.

If something is declined, ask for the specific clause. Most refusals turn on a definition — pre-existing, chronic, or outside the list — and each needs different evidence to challenge.

Questions to put to the insurer or broker

  • Do I need a GP referral or can I self-refer?
  • Will you confirm the consultant, hospital and fees in writing?
  • How is the excess collected?

Related questions

Sources

  • Source: AXA Health — Personal Health membership handbook, October 2024, read 4 September 2026.
  • Source: Bupa policy guide — Bupa By You health insurance (BINS 14718) (2024), read 4 September 2026.

The limit behind every answer here

None of this reaches a condition you already have. Cover is written for problems that arise after it starts, so anything you have symptoms of when you apply is excluded — permanently under full medical underwriting, or until a symptom-free period has passed under a moratorium. Chronic conditions are excluded by every insurer whose wording we hold. Figures quoted come from current policy documents and change at renewal, so check the document you are actually offered.

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