Private Health Insurance Claim Declined? Steps to Take

If an insurer declines a claim, ask for the decision and the specific policy terms it relied on in writing. A decline may relate to an exclusion, medical history, missing information, an unauthorised provider or a limit—not necessarily the same issue in every case.

Review the decision

Compare the explanation with your policy schedule, wording, underwriting terms and authorisation. Check that the insurer has the correct medical information and claim documents. If something is missing or inaccurate, ask how to provide it and request a review.

Make a formal complaint if needed

Use the insurer’s complaints process and explain what you believe is wrong, attaching relevant records. Keep copies and note dates. If the insurer issues a final response you disagree with, or does not resolve the complaint within the applicable period, you may be able to refer it to the Financial Ombudsman Service.

Should I continue treatment while disputing a decision?

Ask your clinician and insurer about costs before proceeding. Do not assume the insurer will reimburse treatment while a dispute is open.

See our guide to claiming on private health insurance.

Sources checked 18 October 2026: Financial Ombudsman: Private medical insurance claims · FCA: How to complain