Updated April 2026
Covers Bupa, AXA, Aviva, Vitality, WPA & The Exeter
Includes copy/paste phone script & email template
Independent — not affiliated with any insurer
Health Insurance · UK · 2026
Health Insurance Pre-Authorisation Codes — what they are, how to get one & avoid claim pitfalls
Quick summary
A pre-authorisation code is your insurer’s written approval to fund a specific consultation, scan or procedure. Without one, you risk paying out of pocket or having your claim refused. You need one for most MRI/CT/ultrasound scans, specialist consultations and any day-case or inpatient surgery. This guide covers every UK insurer with exact steps, copy/paste scripts and the most common reasons claims get refused.
8
UK insurers covered
#1
Reason claims refused
5 min
To get a code (if prepared)
£0
Cost to pre-authorise
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The basics
What is a pre-authorisation code?
A pre-authorisation code (also called an authorisation number, pre-auth code or reference number) is the confirmation from your health insurer that they will fund a specific episode of private medical care. Think of it as a green light — issued before you attend, confirmed in writing, and used by the hospital and consultant to invoice your insurer directly.
Without a pre-authorisation code, two things can happen: the hospital may ask you to pay a deposit or the full amount upfront (and you reclaim later — which isn’t always guaranteed), or your insurer may simply refuse to pay when the claim arrives. Neither is a position you want to be in while you’re unwell.
What a pre-auth code confirms
- Who: Your policy details, the named consultant, and the specific hospital or clinic
- What: The procedure or diagnostic scan, often referenced by a CCSD code
- When: The date or episode of care being authorised
- How much: Any excess you need to pay, benefit limits remaining, and whether shortfalls are expected
Key point: A pre-authorisation code confirms eligibility — but it doesn’t guarantee every penny is paid. Your excess still applies, outpatient limits still count, and if your consultant charges above the insurer’s fee schedule, a shortfall may arise. Always ask about all of these when you call.
Do you need one?
When you need pre-authorisation — and when you don’t
Always get pre-authorisation for:
- MRI scans, CT scans, PET-CT scans and ultrasound
- Specialist consultant consultations (new episodes)
- Endoscopy, gastroscopy and colonoscopy
- Echocardiogram and cardiac investigations
- Day-case and inpatient surgery of any kind
- Physiotherapy (on most plans — check your policy)
- Mental health treatment beyond initial triage
You may not need pre-authorisation for:
- Bupa Direct Access: MSK and mental health pathways allow you to start care without a GP referral and without a separate pre-auth call in some cases
- AXA guided care: Some pathways issue authorisation as part of the referral process
- Vitality pathways: Virtual GP and app-based routes sometimes combine consultation and authorisation
- Self-pay treatment: If you’re paying privately without insurance, no code is needed
When in doubt — call first. Even if you think you don’t need pre-authorisation, a 5-minute call to confirm is infinitely cheaper than finding out your claim has been refused after treatment. Every insurer has a pre-authorisation line available during business hours.
Not sure your current policy covers what you need?Compare health insurance with better outpatient cover, direct access and simpler pre-auth — free, no obligation
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Step by step
How to get a pre-authorisation code — exact steps
1
Get your referral
Obtain a GP or consultant referral letter stating your symptoms, suspected diagnosis, and the specific test or treatment requested. Most insurers accept digital referrals. Some pathways (Bupa Direct Access, AXA guided care) allow you to bypass this step for MSK and mental health conditions.
2
Choose your consultant and hospital
Confirm they are recognised by your insurer and on your hospital list tier. In London especially, check whether your hospital is on a standard, extended, or London-surcharge tier — the difference can be hundreds of pounds per treatment episode.
3
Get the CCSD procedure code
Ask the consultant’s secretary or hospital pre-assessment team for the CCSD code for your planned procedure. This is the reference your insurer uses to identify exactly what’s being done and apply the correct benefit category and fee schedule.
4
Call your insurer (or use their app)
Use the phone script below. Have ready: policy number, your name and DOB, consultant name and GMC number, hospital name and site, diagnosis/symptoms, CCSD code, and proposed date. Your insurer will check eligibility and issue a code.
5
Record everything and share the code
Note the authorisation number, exactly what it covers, your remaining excess, any benefit limits, and the expiry date. Share the code with the hospital and consultant’s billing team — they use it to invoice your insurer directly.
| What your insurer will ask | Where to find it |
|---|---|
| Policy/membership number | Digital portal, app or policy schedule |
| Full name & date of birth | Your personal details (or dependant’s) |
| Consultant name & GMC number | On your referral letter or hospital booking team |
| Hospital name and site | Hospital booking letter or website |
| Diagnosis or suspected condition | GP or consultant referral letter |
| CCSD procedure code | Consultant’s secretary or pre-assessment team |
| Proposed treatment date | Clinic or theatre booking team |
Each insurer explained
Pre-authorisation by insurer — what actually happens
Every UK insurer handles pre-authorisation slightly differently. Here’s what to expect from each major provider in 2026:
Bupa
Fee-assured network
Generally fast for recognised consultants. Direct Access pathways for MSK and mental health can bypass GP referral. Fee-assured consultants charge within Bupa limits — shortfalls rare if you stay in network. Open referral (to specialty, not named consultant) is increasingly preferred. Full Bupa claims guide →
AXA Health
Guided care pathway
May route you via the Fast Track Appointments team, which recommends a fee-approved consultant. Guided care can feel restrictive but significantly reduces shortfall risk. Open referral required — AXA prefers referrals to a specialty rather than a named consultant. Full AXA claims guide →
Aviva
Expert Select network
Expert Select network recommends hospitals and consultants. Out-of-network choices can trigger shortfalls, especially in London where surcharges apply. Ask specifically whether your chosen hospital is on the standard or extended tier before booking. Aviva procedure codes guide →
Vitality
Rewards-linked pathways
Authorisation often tied to selected network providers to control costs. Virtual GP service can issue referrals directly. App-based authorisation available for some claim types. Shortfalls can occur if using out-of-network consultants. Vitality procedure codes guide →
WPA
Flexible benefit structure
Generally straightforward if the consultant is recognised and codes match your plan’s benefits. WPA’s modular policy structure means your specific benefits vary significantly depending on how your plan was set up — always check what’s included before calling.
The Exeter
HealthWise app
Unlimited GP access via HealthWise app can facilitate faster referrals. Pre-authorisation process straightforward for recognised providers. Good for active people managing MSK conditions who need efficient pathways.
Freedom Health
Straightforward process
Generally straightforward pre-authorisation if your condition and provider are recognised. Check your plan’s hospital list and consultant recognition status before calling. Freedom is often competitive on price for self-employed and small business owners.
Saga
Over-50s specialist
Saga health insurance is underwritten by AXA Health — the pre-authorisation process follows AXA’s pathways. If you have a Saga policy, the AXA guided care process and fee schedule apply. Contact the number on your Saga policy documents.
Thinking about switching insurer?Compare which policies make claiming easiest — hospital access, direct access and pre-auth simplicity
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The codes explained
CCSD & OPCS codes — why they matter and where to get them
CCSD codes (Clinical Coding and Schedule Development) are the standard procedure codes used across UK private healthcare to describe treatments. They allow your insurer to identify exactly what procedure is planned, apply the correct benefit category, and issue authorisation for the right amount.
Common CCSD code examples
- MRI scan (head): W850
- MRI scan (spine): W851/W852
- Ultrasound (diagnostic): U031–U090 range depending on area
- CT scan: X300–X399 range depending on area
- Knee arthroscopy: W851 (varies — always confirm)
Never guess the code. Ask the consultant’s secretary or the hospital pre-assessment team for the exact CCSD code they intend to use — in writing, before you call your insurer. The difference between two similar codes can change whether something is classed as day-case or inpatient, or whether a device is included in the fee.
OPCS and ICD-10 codes
Some insurers also reference OPCS-4 codes (used by NHS and some private coding) and ICD-10 diagnostic codes. These are more common in complex claims and surgical pre-authorisations. Your consultant or hospital team will provide these if needed — you don’t need to source them yourself.
Fee schedules and shortfalls
Each insurer maintains a fee schedule — a list of maximum amounts they’ll pay for each CCSD code. If your consultant charges above this limit, the difference is a shortfall that you pay personally. To avoid this:
- Use fee-assured or fee-approved consultants (recognised by your insurer)
- Ask the consultant explicitly: “Do you charge within [insurer’s] fee schedule?”
- For London hospitals, check whether a London surcharge applies to your hospital tier
Common pitfalls
Top reasons pre-authorisation is refused — and how to fix them
No pre-authorisation at all — The single biggest reason claims are refused. Even if your condition is covered, treatment without a pre-auth code can result in the full cost falling to you. Always call before you attend.
1. No referral or incomplete referral notes
Your insurer needs to see a GP or consultant referral letter stating your symptoms, suspected diagnosis, and the requested test or treatment. A referral that simply says “please see” without clinical detail will often be rejected. Request a detailed letter from your GP and provide it when you call.
2. Using a non-recognised consultant or hospital
Consultants and hospitals must be on your insurer’s recognised list. If your chosen consultant isn’t fee-approved, expect a shortfall — or outright refusal if they’re not recognised at all. Check before booking, not after.
3. Benefit not included in your plan
Many claims are refused because the treatment isn’t covered under your specific plan level. Common examples: no outpatient diagnostics cover, physiotherapy not included, mental health pathways not activated, or outpatient limit already exhausted. Review your policy schedule before calling.
4. Moratorium or waiting period
New policies often temporarily exclude conditions that were present or investigated before the policy start date. Under moratorium underwriting, these exclusions typically lift after two continuous symptom-free years. See our guide on CPME vs moratorium underwriting.
5. Six-week NHS option triggered
Some policies include a six-week wait condition — if the NHS can treat you within six weeks, your policy directs you to NHS care rather than funding private treatment. Understand your policy’s rules before assuming private treatment is automatically covered.
Had a claim refused? Thinking of switching?Compare policies with clearer claiming rules — outpatient cover, direct access and simpler pre-auth
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Copy & paste
Phone script & email template — use these word for word
Phone script — call this in
Have your policy number, consultant details, CCSD code and referral to hand before you call. Read this script directly:
Phone script
“Hi, I’d like to request pre-authorisation for private treatment.
My policy number is [POLICY NUMBER] and my name is [FULL NAME], date of birth [DOB].
I have been referred by [GP/CONSULTANT NAME] for [PROCEDURE/SCAN DESCRIPTION].
I would like to use [CONSULTANT NAME], GMC number [GMC NO.], at [HOSPITAL NAME AND SITE].
The proposed date is [DATE] and the CCSD procedure code is [CODE].
Could you please:
1. Confirm this treatment is covered under my policy
2. Issue a pre-authorisation code
3. Confirm my remaining excess and any outpatient limits
4. Advise whether my chosen consultant is fee-assured
5. Confirm whether any shortfall is expected
Could you also send the authorisation confirmation in writing to [EMAIL]?”Email template — confirm in writing
Always follow up a phone call with an email to create a paper trail. Send this to your insurer’s pre-authorisation email address (found in your policy documents or app):
Email template
Subject: Pre-Authorisation Request – [FULL NAME] – Policy [POLICY NUMBER]
Dear [INSURER NAME],
Please confirm pre-authorisation for the following planned treatment:
Member details:
– Full name: [NAME]
– Date of birth: [DOB]
– Policy/membership number: [NUMBER]
Treatment details:
– Consultant: [NAME], GMC number: [GMC NO.]
– Hospital/clinic: [NAME AND SITE]
– Procedure/scan: [DESCRIPTION]
– CCSD code: [CODE]
– Proposed date: [DATE]
I have attached my referral letter from [GP/CONSULTANT NAME] dated [DATE].
Please confirm:
1. Pre-authorisation code and its scope
2. Whether my excess applies and the remaining amount
3. Any outpatient benefit limits remaining
4. Whether my consultant is fee-assured (no shortfall expected)
5. Expiry date of the authorisation
Many thanks,
[YOUR NAME]
[PHONE NUMBER]Keep everything. Save the authorisation reference number, the name of the person who confirmed it, the date and time of the call, and any written confirmation. Share the code with your consultant’s billing team and the hospital — they’ll need it to invoice your insurer directly.
Common questions
Frequently asked questions — pre-authorisation codes UK
Not always. Some insurers use a single reference number for the entire claim, from pre-authorisation through to settlement. Others issue separate codes for each stage — one for the consultation, another for the scan, another for the procedure. When you call to pre-authorise, ask explicitly: “Is this code valid for the full episode of care, or will I need a separate code for each stage?”
Typically for the duration of that treatment episode, but codes do expire. Always ask for the validity window when you receive your code. If your appointment date changes, contact your insurer to renew or extend the authorisation before the expiry date. Attending on an expired code is treated the same as attending without one by most insurers.
It is possible in genuine emergencies — if you were admitted to hospital urgently and couldn’t call first, most insurers will consider retrospective authorisation. For planned treatment, retrospective authorisation is rarely granted and often results in a refused claim. The rule is simple: always call before you attend, not after.
Not always. Bupa Direct Access, AXA guided care pathways, and Vitality’s virtual GP service can all facilitate referrals without a separate GP visit for certain conditions — particularly MSK (musculoskeletal) and mental health. However, for complex investigations, surgery or specialist consultations in other specialties, a GP or consultant referral is usually required. Check your specific plan’s rules.
Check your hospital list first. Many policies have tiered hospital access — standard, extended, and London lists — with different premiums attached. If your chosen hospital or consultant isn’t on your tier, you may be able to upgrade at renewal or pay a shortfall for individual treatments. For London hospitals specifically, check whether your policy includes or excludes the major private groups (HCA, Spire, Nuffield) at central London sites.
Pre-authorisation itself doesn’t affect your premium — making a claim can. Many policies have a no-claims discount that reduces if you make a claim. Whether pre-authorising a claim that ultimately isn’t paid out (e.g. if you go to NHS instead) affects your NCD varies by insurer. Ask specifically when you call: “Will requesting pre-authorisation count as a claim on my policy if I don’t go ahead with private treatment?”
Ask for the refusal in writing, including the specific policy clause or reason. Provide additional evidence — your referral letter, clinical notes, and any supporting documentation. Submit a formal appeal through your insurer’s complaints or appeals process. If you remain unhappy, you can escalate to the Financial Ombudsman Service. Most insurers have a formal appeals process that’s separate from the initial pre-authorisation call.
Keep reading
Related guides
Disclaimer: This guide is for general information only and does not constitute medical, financial or insurance advice. Pre-authorisation rules, benefit limits, fee schedules and processes vary by policy and insurer and may change. Always check your specific policy documents and confirm authorisation directly with your insurer before booking any private treatment. Going Private UK is independent and not affiliated with any insurer mentioned.
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