About to book a scan or see a consultant and your insurer has asked for a pre-authorisation code? This 2025 UK guide explains when you need one, the exact steps to get it from Bupa, AXA, Aviva, Vitality, WPA, Saga, Freedom and The Exeter, what information to have ready (CCSD/OPCS codes, referral notes), and the most common reasons claims get refused.
Last updated: 3 October 2025
In brief
- A pre-authorisation code (sometimes called an authorisation number) is your insurer’s approval to pay for a specific consultation, test or treatment.
- You usually need one before you attend the appointment — especially for diagnostics (MRI/CT/ultrasound), day-case or in-patient procedures.
- Have ready: policy number, referral (GP/consultant), hospital & consultant, CCSD code (if known), and the date.
- If you’re unsure, many insurers provide guided care where they’ll suggest a networked consultant/hospital that fits your cover limits.
💡 Need treatment soon? See which policies make pre-authorisation easiest (and cheapest) →
Contents
- What is a pre-authorisation code?
- When you need one (and when you don’t)
- How to get a code: step-by-step
- Insurer specifics (Bupa, AXA, Aviva, Vitality, WPA & others)
- CCSD/OPCS codes explained
- Guided care vs consultant choice
- Top reasons authorisation is refused
- Call scripts & email template
- FAQs
What is a pre-authorisation code?
A pre-authorisation code is the reference your insurer issues to confirm they’ll fund the treatment you’re about to have. It ties together the who (your policy details, named hospital and consultant), the what (diagnostic or procedure, often with a CCSD or OPCS code), and the when (date/episode).
Hospitals and consultants use this code to invoice your insurer. Without it, you may be asked to pay a deposit or the full amount yourself and reclaim later (which isn’t always guaranteed).
Not sure on where to go? Compare networks and hospital access by insurer: Bupa, Aviva, AXA, Vitality, WPA.
When you need one (and when you don’t)
- Usually required: Specialist consultations (new episodes), MRIs, CTs, ultrasound, endoscopy/gastroscopy, colonoscopy, echocardiogram, day-case and in-patient surgery.
- Sometimes not required: Policies with direct access for mental health or MSK may let you start triage without a GP referral (e.g., see Bupa Direct Access and Vitality pathways).
- Self-pay: If you choose to pay privately, no code is needed — compare typical prices in our Private Hospital Price List.
How to get a pre-authorisation code: step-by-step
- Referral in hand: Obtain a GP or consultant referral stating the condition and requested test/treatment (insurers may accept e-referral portals).
- Choose clinician & hospital: Confirm they’re recognised by your insurer and on your hospital list tier (London surcharges may apply — see Bupa / Aviva / AXA details).
- Gather details:
| What your insurer will ask | Where to find it |
|---|---|
| Policy/membership number | Your digital portal or policy schedule |
| Full name & DOB | You (member) or dependant details |
| Consultant name & GMC no. | On referral or the hospital booking team |
| Hospital/location | Hospital booking letter or website |
| Diagnosis/suspected condition | GP/consultant referral |
| Procedure/scan (CCSD/OPCS code) | Consultant secretary/hospital pre-assessment |
| Proposed date | Clinic/theatre booking team |
- Call your insurer (or use their app/portal) and request pre-authorisation. They’ll issue a code if it’s covered.
- Share the code with the hospital/consultant billing team.
- Keep records: Note the authorisation number, what it covers, any excess, and expiry date.
🔎 See: How to claim on Bupa · How to claim on AXA · Aviva · Vitality · WPA
Insurer specifics (what typically happens in 2025)
- Bupa: Often issues codes quickly for recognised consultants/hospitals. Direct Access can bypass GP referral for some MSK/mental-health pathways.
- AXA Health: May route you via the Fast Track Appointments team (guided care). Ensures you see a fee-approved consultant in your network.
- Aviva: Expert Select network recommends hospitals/consultants. Out-of-network choices can trigger shortfalls.
- Vitality: Pathways and rewards ecosystem; authorisation often tied to selected network providers to control costs.
- WPA, Saga, Freedom, The Exeter: Generally straightforward if the consultant is recognised and codes match your plan’s benefits.
Note: Exact rules vary by plan (e.g., outpatient limits, excess, six-week NHS option). See Outpatient Limits, Six-Week NHS Option, and Guided vs Consultant Choice.
CCSD/OPCS codes explained (and why they matter)
CCSD codes are standard procedure codes used by UK private healthcare to describe treatments (e.g., W850 for MRI head). OPCS and ICD-10 codes may also be referenced. Using the correct code helps the insurer confirm cover and issue the right authorisation.
Where to get the code: Ask the consultant’s secretary or hospital pre-assessment team. For diagnostics, radiology can often confirm the appropriate CCSD code once they know the body area and scan type (MRI, CT, ultrasound, PET-CT, etc.).
Guided care vs consultant choice
Some policies are sold as guided (you pick from the insurer’s recommended clinicians), while others allow full consultant choice. Guided plans cut costs but can restrict hospitals, especially in Central London. If your plan is guided and you insist on a non-network consultant, expect to pay a shortfall.
Check our hospital list explainers to avoid surprises: Bupa · Aviva · AXA · Vitality · WPA.
Top reasons pre-authorisation is refused (and easy fixes)
- No referral or incomplete notes: Provide a GP/consultant letter stating symptoms/diagnosis and the requested investigation.
- Using a non-recognised consultant/hospital: Switch to an in-network provider or accept a shortfall.
- Benefit not on your plan: e.g., no outpatient diagnostics or physiotherapy. Consider self-pay or upgrading at renewal.
- Waiting periods/moratorium: New policies may temporarily exclude recent conditions. See Moratorium vs Full Medical Underwriting.
- Six-week NHS option triggered: If the NHS can treat you within six weeks, your policy might direct you to the NHS. Understand the trade-off: lower premiums vs flexibility.
⚠️ Rejected or limited authorisation? Use our appeal templates →
Call scripts & email template (copy/paste)
Phone script to request pre-authorisation
Hi, I’m calling for pre-authorisation. My policy number is [POLICY NO.]. I’ve been referred to [CONSULTANT NAME, GMC] at [HOSPITAL] for [PROCEDURE/SCAN]. Proposed date is [DATE]. The CCSD code is [CODE] if needed. Could you confirm this is covered and issue an authorisation code, and let me know any excess or limits?
Email template to confirm in writing
Subject: Pre-Authorisation Request – [NAME, POLICY NO.] Dear [INSURER], Please confirm pre-authorisation for: * Member: [NAME, DOB, POLICY NO.] * Consultant: [NAME, GMC], Hospital: [HOSPITAL] * Procedure/Scan: [DESCRIPTION], CCSD: [CODE] * Date: [DATE] * Referral attached Kindly confirm the authorisation code, scope of cover, any excess/shortfall, and expiry. Thanks, [NAME]
💡 Prefer simpler claims? Compare policies with easy pre-auth & wider hospital lists →
FAQs
Is a pre-authorisation code the same as a claim number?
Not always. Some insurers use a single reference for the whole claim; others issue new codes for each stage (consultation, scan, procedure). How long does a code last?
Typically for that treatment episode. Codes can expire — ask for the validity window and renew if dates move. Can I get authorisation after treatment?
It’s risky. Some insurers can retrospectively authorise, but many won’t. Always get approval first unless it’s a genuine emergency. Do I always need a GP referral?
Often yes, but Direct Access and some pathways allow triage without one. Check your plan rules. What if I want a specific London hospital?
Check your hospital list. If out-of-network, expect a shortfall. Consider plans with Extended Choice hospital lists. Will authorisation affect my renewal?
Claims can influence premiums and no-claims discounts. See No-Claims Discount and Renewal Negotiation.
✅ Get a policy that streamlines pre-authorisation → Explore our Health Insurance Hub →
Related guides
- How to claim on Bupa · AXA · Aviva · Vitality · WPA
- Guided vs Consultant Choice
- Six-Week NHS Option
- CPME underwriting explained
- Diagnostics Hub · Hospital Price List (UK)
For informational purposes only.
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