Get Bupa Uplift Form

Filling out the Bupa Uplift Form online is an essential step in requesting an uplift for surgical fees. This guide provides a clear and supportive walkthrough of the form’s components, ensuring that you can complete it accurately and efficiently.

Follow the steps to successfully complete the Bupa Uplift Form online.

1. Press the ‘Get Form’ button to access the Bupa Uplift Form. This will allow you to open the form in your preferred editing tool.
2. Begin by filling out Section 1, 'About the patient.' Include all requested information such as the patient's first name, last name, date of birth, address, postcode, and Bupa membership number.
3. Proceed to Section 2, 'About the consultant and hospital.' Here, you will need to enter the name of the requesting consultant, their specialty, and the name of the hospital. Additionally, confirm whether the patient has been informed about the fees and charges.
4. In Section 3, provide the pre-authorisation number if available, along with the procedure information including the reason for the procedure, date of the procedure, and details of the consultant performing it.
5. Detail the clinical rationale for the uplift request in Section 4. If necessary, you can continue on a separate page.
6. Complete Section 5 with your declaration. The consultant must sign and print their name, include their Bupa provider number, and indicate how they would prefer to be notified about funding eligibility.
7. Finally, in Section 6, confirm that all additional documents, such as operation notes and anaesthetic charts, are included. This is crucial for the assessment of the uplift request.
8. Once all sections are filled out accurately, save the changes, and choose to download, print, or share the completed form as needed.

Take the next step in your surgical fee request process by completing the Bupa Uplift Form online.