Guide to direct insurance claims

Focus Referrals normally requests our insured clients to pay for the treatment and then claim back from the insurance company. In this situation we will do all that we can to ensure this process takes place quickly and efficiently to ensure you receive the money back from the insurance company as soon as possible.

However, on occasions (e.g. a large elective operation such as cataract surgery), a direct claim can be arranged, whereby the insurance company pays the host practice directly.

Please note – direct claims cannot be performed with all insurance companies

Pre-authorisation

Initially the proposed treatment/surgery needs to be pre-authorised by the insurance company, which can take up to 72 hours, depending on the insurance company. This process will incur a small administration fee (£9.27 including VAT) for each insurance claim form submitted, for which the insurance company will not reimburse you.

Focus Referrals will complete the pre-authorisation form to your insurance company and provide a detailed estimate. The insurance company will then give a YES/NO answer as to whether your policy will cover the proposed costs. Assuming the answer is YES then the surgery can be scheduled at a convenient time.

Ongoing direct claims

If you have already completed a direct claim for your pet for a specific condition and the remaining funds on your policy are sufficient for the ongoing veterinary fees, then an ongoing direct claim can be granted. You as the client would be expected to pay the administration fee (£9.27 including VAT per form completed) as well as any shortfalls to the host practice.

Emergency situation

In emergency situations, for example when your pet requires the surgery immediately, a pre-authorisation is not possible. In this situation, a direct claim can only be agreed by Focus Referrals, following direct inspection of your insurance policy and pet’s medical history.

Please ensure you bring your insurance documentation with you in an emergency appointment situation.

Please note that any agreement of Focus Referrals to make a direct claim on your behalf does not constitute a contract between your insurance company and Focus Referrals and we ask that you settle any outstanding balances that have not been paid by your insurance company after 42 days with us.

In addition any shortfall in the cost of treatment not covered by your insurance company (e.g. excess) will be payable by you to the host practice at the time of making the first direct claim. In addition, if for whatever reasons the insurance company fails to settle your claim (e.g. if the condition being claimed for was pre-existing) you will be liable to pay the final bill to the host practice in full.