Private Health Insurance Pre-authorisation: What It Means

Pre-authorisation is an insurer’s decision, made before care takes place, about whether a proposed consultation, test or treatment appears eligible under your policy. It is not a guarantee that every related cost will be paid: exclusions, benefit limits and the final diagnosis can still matter.

What to do before booking

Ask your insurer how to open a claim and what information it needs. This may include a referral, symptoms, a proposed treatment plan and the consultant or hospital’s details. Get an authorisation or claim reference and ask which services and providers it covers, any excess or shortfall, and whether follow-up appointments need separate approval.

Why it matters

If you arrange care before approval, you may be responsible for costs the insurer would not have authorised. Keep the authorisation details and check with the insurer if the treatment plan changes.

Is pre-authorisation the same as a referral?

No. A referral recommends assessment by a clinician; pre-authorisation is the insurer’s coverage check. You may need both.

Read our claiming guide and outpatient-cover guide before arranging care.

Sources checked 18 October 2026: PHIN: Paying for treatment with private medical insurance · Bupa By You policy guide