How long do health insurance claims take to pay?

There is no single number of days for a health insurance claim: it turns on the insurer, the kind of claim and whether the money goes to you or to the hospital. What is fixed is the legal standard: an insurer has to pay what is due within a reasonable time, and what counts as reasonable depends on the claim. How fast an insurer pays can tip a choice between two policies. Claims handling is something a broker with FCA authorisation can lay side by side for two insurers during the free ring-back arranged by the form on this page.

The sections below separate the stages a claim goes through, say which of them the law puts a clock on, and cover what to do if yours stalls.

Is there a legal deadline for paying a health insurance claim?

Not a number of days. Section 13A of the Insurance Act 2015 (legislation.gov.uk, read 1 November 2026) makes it a term of every insurance contract that "the insurer must pay any sums due in respect of the claim within a reasonable time". The same section adds: "A reasonable time includes a reasonable time to investigate and assess the claim."

The Act lists what may be taken into account, and the examples include the size and complexity of the claim and factors outside the insurer's control. A simple claim for a consultation therefore sits differently from a long, multi-stage course of treatment. Where an insurer shows it had reasonable grounds for disputing a claim, it does not breach the term merely by not paying while that dispute continues, although the way it handles the claim can still count in deciding whether, and when, the term was broken.

The FCA's insurance rulebook sets the conduct standard beside it. ICOBS 8.1.1R (rule dated 6 January 2008, on a Handbook page last updated 1 August 2017, read 26 October 2026) says an insurer must "handle claims promptly and fairly", "provide reasonable guidance to help a policyholder make a claim and appropriate information on its progress", and "settle claims promptly once settlement terms are agreed". Together these mean you are entitled to be told where a claim stands, even though neither the Act nor the rulebook says how many days that should take.

Why a claim takes weeks when the payment is the short part

On a policy that authorises treatment before it happens, much of the waiting can come before any money moves. General & Medical Healthcare, which handles claims on the health cover it sells, lays out its own sequence on its claims page: see your GP, send the claim form with an open referral letter, wait for approval, and have treatment only after that. It warns that "if you attend any treatment prior to authorisation by us, this will be at your own financial risk." Other insurers and providers set their own steps, so treat this as one example of a common pattern rather than a rule for every policy. The GP-referral stage is covered on the private GP referral page.

The same page says that after treatment "please ask for invoices to be sent to us directly", and that General & Medical will contact you if you need to pay anything on the invoice, such as an excess. If you want to know how that excess works, the excess page explains it.

That sequence puts the delays in three places you can partly influence:

• The claim form and referral letter. An incomplete form or a referral that does not name the type of specialist gives the insurer something to come back to you about.
• The claim check. General & Medical says that "there may be times where we need to request further information from your GP in order to progress your claim", and says it can request your medical records using a Data Subject Access Request form you give to your GP. While that request is with the surgery, the claim may be waiting on a third party.
• The invoice. The hospital or consultant has to bill the insurer, or you do, before the payment stage can start.

When the insurer pays you, and when it pays the provider

Whether you wait for a payment depends on who is owed the money. Where the insurer settles with the hospital, you may have little or nothing to wait for beyond any excess. Where you pay first and claim back, you are waiting for a reimbursement. AXA Health's member support page (read 1 November 2026) says members can, through their online account, "claim back any money you're due", and that AXA can "pay you directly into your bank account". Refund speed varies between insurers, so ask the broker during your free ring-back how quickly the ones on your shortlist pay members back.

Cash plans work the opposite way round. Simplyhealth's policy says you pay the provider first and claim afterwards, and its claiming help page (read 29 October 2026) says claim payments typically reach your account within 10 days of the claim being submitted. The details, with the dates, are on the Simplyhealth cash plan claim page. That is a cash plan, which pays towards everyday costs rather than hospital bills, so its timing says little about a private medical insurance claim for surgery.

Can a published approval rate tell you how fast an insurer is?

Not on its own. WPA's own "Learn more about who we are" page (read 29 October 2026) shows 97% beside the label "Claims authorised", for "all eligible health insurance claims received". That is a measure of how many eligible claims are approved, which is a different thing from how long approval takes. An insurer that approves nearly every claim can still be slow, and a fast one can still decline many. If speed matters to you, find out whether each insurer states a target for settling claims, and in which document.

What to do when a claim has gone quiet

Start with the progress rule above: you are entitled to "appropriate information on its progress", so ask what the claim is waiting on. It is often a document, a GP response or an invoice, and you may be able to supply or chase it yourself. Keep a note of dates and names.

A claim that is declined rather than delayed is a different problem: ask the insurer to explain the decision in writing, and see the page on rejected claims for how to challenge it.

If a delay does not move, make a formal complaint to the insurer. The Financial Ombudsman Service (how-to-complain page, read 26 October 2026) says a business has up to 8 weeks to consider most complaints, and that if the business has not responded within the time limits you can refer the complaint to the Ombudsman. An insurer's own complaints timetable may be set out in its guide; Freedom's is described on the Freedom claims page.

Four things to settle about speed before you pick an insurer

Because the law sets no day count, speed is something to ask about, not assume. A short list worth taking to the call-back:

• Does the insurer ask for pre-authorisation before every course of treatment, or only some?
• Does it settle with the hospital directly, or do I pay and claim back, and does the answer change for out-patient bills?
• Does the insurer state a target for how quickly it settles claims, and where is that written?
• If I have an earlier condition, will it ask for GP records at claim stage, and who will request them?

The form collects only your name, age band, phone, email and postcode; the detail of your own situation comes up on the call. Those four answers, put to several insurers in one conversation, are what the broker is for. For how a broker is paid, the broker costs page explains.

Odd corners of claim timing

Can an insurer hold up payment while it checks my medical history?

Within limits, yes. The Insurance Act 2015 says a reasonable time to pay "includes a reasonable time to investigate and assess the claim", so a check of GP records can fall inside that. It still has to be reasonable, and the insurer must keep you informed of progress.

Does a hospital stay take longer to claim than a consultation?

A longer, more complex course of treatment is more likely to need more than one approval, and the Act names the size and complexity of a claim as a factor in what is reasonable. How a given insurer staggers its approvals is in its own policy documents, so check the documents for the policy you are considering.

Is there a typical wait for a Bupa claim?

Each insurer's claims process and any timescales it commits to are in its own policy documents. On your call-back, ask how each insurer handles claims in practice; the broker can set out what their policy papers say. For Bupa's route in, the Bupa claims page sets out the steps.

Is my claim late if I am still waiting after a month?

There is no set number of days that makes a claim late. What matters is whether the time taken is reasonable for the claim, and whether you are being told what it is waiting on. If it is not moving, use the complaint route above.

Who pays the hospital bill while a claim is open?

It depends on the policy. Under some, the insurer settles the invoice with the hospital after authorising treatment, and under others you pay and claim back. Treatment that starts without authorisation can be at your own cost, as the General & Medical example above shows.