How to claim for medical treatment

How to claim for medical treatment

Whether you’re making a claim for a doctor visit or you need treatment in a hospital, you’ll find information on this page about what to do.

If you are unsure and would like to speak to someone, give us a call on +44 (0) 1276 486 460. Our team works 0600-1800 (GMT), Monday to Friday. You can also email your question to claims@william-russell.com.

How to claim for outpatient treatment

Outpatient treatment is medical treatment you receive that doesn’t require your admission to hospital. Doctor visits, consultations with a specialist, scans and imaging tests, and physiotherapy sessions are all examples of outpatient treatment.

We ask you to pay the bill for your outpatient treatment yourself, then claim back your expenses from us later. This practice is sometimes called ‘pay and claim’, or ‘reimbursement claiming’.

Follow these steps when you need outpatient treatment.

1. Before you receive your treatment—Feel free to ask us whether your plan covers your proposed outpatient treatment. You can also check for yourself by reading your certificate of insurance and checking the table of benefits in your plan agreement. We need to pre-authorise certain types of outpatient treatment.
2. Pay the bill—Once you’ve received your treatment, ask your doctor for a fully itemised invoice. Pay this invoice, then keep a copy of the invoice and receipt. If the invoice exceeds US$500 (or equivalent in another currency), please ask your doctor to complete Section B of this PDF form.
3. Complete our online form—Complete our online claim form for outpatient treatment. The form will ask you to upload a photograph or scan of your invoices, receipts, and any other relevant document.
4. We reimburse you—We review your claim and reimburse your eligible expenses.

When you need inpatient or daypatient treatment

Inpatient treatment is medical treatment you receive that requires your overnight admission to hospital. Surgical cancer treatment, transplants, or treatment following a stroke or cardiac problem are examples of treatment that will likely require you to spend one night or more in hospital. Sometimes, you might be formally admitted to hospital but you don’t need to stay overnight. This is called daypatient treatment, and we treat it in the same way as inpatient treatment.

When you need eligible inpatient treatment, we pay your bill directly to the hospital or clinic where you receive that treatment.

Follow these steps when you know you need inpatient treatment.

1. Contact us—As soon as you know you need medical treatment that requires your admission to hospital, please complete our online pre-authorisation form for inpatient treatment. The form will ask you to upload a photograph or scan of your doctor’s medical notes.
2. We pre-authorise your treatment—We’ll contact the hospital or clinic where you’ll be receiving treatment and ask them for the necessary medical information. If your plan covers the proposed treatment, we’ll attempt to send the hospital our guarantee that we’ll pay for your treatment. There are some situations where we may not be able to settle your medical bills directly with the hospital. For instance, remote clinics in parts of Africa cannot handle international payments. In these cases, we’ll work with you and the hospital to find a way to settle the bills.
3. We settle your bills—Once you’ve received your treatment and the hospital has sent us the final invoice, in most cases we’ll pay your bill directly to the hospital.

Please contact us at least 5 days before the date of your admission to hospital. This gives us enough time to contact the hospital. If it’s not reasonably possible for you to contact us in advance (e.g., you’re admitted to hospital following an accident), please contact us within 24 hours of your admission.

If you’re pregnant and you want to claim for private maternity care

If you’re pregnant and your plan gives you cover for routine maternity care, please follow these steps.

1. Complete our claim form—We have a PDF claim form for maternity care. Please print it off and take it to your next appointment with your maternity doctor. You’ll need to complete Section A, and your maternity doctor will need to complete Section B.
2. Keep any invoices and receipts for your ante-natal treatment—Once you’ve received your ante-natal treatment, ask your doctor for a fully itemised invoice. Pay this invoice, then keep a copy of the invoice and receipt.
3. Email everything back to us—Return your completed claim form to claims@william-russell.com, along with copies of your invoices and receipts.
4. Tell us where you’ll be giving birth—Once you are within 2 months of your estimated due date, let us know where you’re planning to give birth and the contact details of your treating doctor.
5. We settle your bills—We’ll contact the hospital where you’ll be giving birth and attempt to send them our guarantee that we’ll pay for your childbirth and related maternity treatment up to the remaining benefit on your plan. If that’s not possible, we’ll work out a solution with you and the hospital. Once you’ve given birth, we’ll pay your bill directly to the hospital.

If you need an emergency medical evacuation

If you suffer a life-threatening or limb-threatening injury or illness, which needs immediate inpatient treatment that isn’t available locally, we’ll arrange your medical evacuation to the nearest suitable location.

1. Call us—Call +44 (0) 1243 621 155 for our 24hr emergency medical assistance helpline.
2. We quickly assess the situation—While our medical team establishes the particulars of your situation, our operations team will assess the situation on the ground.
3. We organise the logistics of your evacuation—We decide on your evacuation destination and the means of transport that best suit your interests. We take into account several criteria, including the severity of your condition and air ambulance availability.
4. Identify your destination hospital—We’ll secure your admission at your destination hospital, sending that hospital our guarantee that we’ll pay for your treatment.
5. Your transport arrives—We’ll collect you from your local medical team and get you into an air ambulance.
6. Returning home—Once you’re ready for discharge from hospital, we’ll pay for your economy return airfare to your country of residence.

By ‘we’, we mean the claims team at William Russell and our assistance service partner, Charles Taylor (formerly called CEGA). We work closely together to organise your evacuation and arrange your treatment at your evacuation destination.