How Equipsme works: How to see a private specialist or consultant for diagnosis

How to use our private diagnosis services available on plan Levels 3, 2, and 1.

Equipsme plans are designed to offer practical, everyday health and wellbeing support. Here’s how to see a private specialist/consultant for diagnosis – if it’s part of your plan.

Who can access private diagnosis?

Equipsme’s specialist diagnosis services, provided by our partners AXA Health, are available to members on plan Levels 3, 2 and 1 (all plans except our Level 4 GP Plus plan).

We want to help you get to a specialist/consultant and get answers about your health, fast.

How to use the private diagnosis services available on plan Levels 3, 2, and 1.

If your plan includes diagnosis cover and your claim is eligible (i.e. not a pre-existing or chronic condition or otherwise excluded) your Equipsme plan may be able to help cut your waiting time by weeks or even months.

You can start by clicking on the Diagnosis icon in your App or portal.

My GP says I need to see a specialist. How do I get an appointment?

First of all, you’re going to need what’s called an open referral letter. This is a general letter from a GP that explains what sort of specialist you need to see and outlines the issue you need to talk to them about.

How do I get an open referral letter?

You can get an open referral letter from your own GP, or from the Equipsme private 24/7 GP, which is available to all members. If you use our GP service and they agree that you would benefit from seeing a specialist, they will email you a copy of the open referral letter.

Do I need anything else to get a referral?

Depending on your health issue, your NHS GP or the Equipsme Health Hero GP might think you need some initial, indicative tests done - to check you’re going to the right kind of specialist.

Remember, the Health Hero is a virtual service, so the doctors will have to refer you back to you NHS GP for things like blood tests or initial diagnostic scans.

Even if Diagnosis is part of your plan, you can’t claim to get back the costs if you choose to get these tests done privately - because the plan cover only applies for private tests or scans that are under the control of a specialist, rather than a GP

After your referral to a specialist consultant (and if your claim is approved by AXA Health as eligible), any further tests or scans they order are included in the plan, with no yearly limit.

I’ve got my letter. Now how do I make an appointment?

Click on the Diagnosis icon.
Call AXA Health on the number provided, or fill in an online claim form.
AXA Health will then assess whether your condition is eligible for cover under the Equipsme plan. If authorised, they will help you make an appointment with one of their recognised specialists or a hospital/clinic for treatment.

What might stop my claim being authorised?

One key example is a pre-existing condition. At Equipsme, we don’t cover issues that you’ve had previously, in the three years before your cover starts.

We define a pre-existing condition as any disease, illness or injury that members:

have received medication, advice or treatment for in the three years before the start of cover, or
have experienced symptoms of in the three years before the start of cover; whether or not the condition was diagnosed.

We do this because we believe insurance is really about covering the unexpected.

We think about it a bit like home insurance. You can’t ask to insure your house after it’s actually on fire, so it seems reasonable you can’t take out health insurance against something that’s already happened or happening.

How do AXA Health assess claims?

AXA Health will need to assess whether your claim is covered, and in some cases (for instance if you’re making a claim when your plan is very new) they might ask for additional information from your own GP to make sure. Only your own NHS GP can access your medical history records.

Some GPs might charge you for the information they provide back to you for AXA Health which you will have to pay as GP fees are not covered under the plan. The good news is that by checking really carefully, AXA Health can make sure that you’re not going ahead with something you’ll end up having to pay for yourself.

What information will I need to speak to AXA Health as well as my open referral letter?

You’ll need your Equipsme plan number and your AXA Health membership number when speaking to AXA Health, which are both on the ‘plan details’ page of your App or portal.

What options will I be given on who to see and where to be seen?

AXA Health will assess and confirm if your claim is covered and if so, offer you a number of specialists or hospitals from their nationwide network, which includes Circle Health, Nuffield Health and Spire Healthcare hospitals. They’ll also help you choose a specialist/consultant from their list of those who specialise in the medical area you need.

You can call to make your appointment from the specialists or hospitals AXA Health offer you, at a time to suit you.

How do I know what specialist/consultant to choose?

Think of AXA Health’s registered specialists like a list of approved repairers if you bump your car! You can always look them up online to do more research - or just choose the one who’s consultancy hours happen to suit you.

Will I have to pay anything at the hospital?

AXA Health will let you know what you’re covered for and give you an authorisation number, if required, for your claim that you can use at the hospital.

If your Equipsme plan Level includes an excess (Level 2 see below), you will have to settle this directly with the provider.

Otherwise you won’t be asked for any money when you get there – just your claim authorisation number.

What about my excess?

Level 2 plan with Equipsme has an excess that applies only if you are claiming under the Diagnosis of Treatment benefits. This is the first amount you have to pay yourself and is £150 per person, per plan year. If your claim continues beyond a renewal date, a further £150 excess will be due. You will usually receive an invoice for you to settle directly.

Why would I use my Equipsme plan and not just wait for an NHS referral?

The NHS is under enormous pressure at the moment, and waiting lists to see certain specialists are getting pretty long. Going through AXA Health can help you skip some of these queues.

The NHS is still a wonderful resource and you can of course go that route if you prefer and it suits your circumstances better, but with your Equipsme plan you’ve got another option to turn to, for the conditions and issues that we cover.

I’m still not sure how it all works!

Don’t worry. The claims team at AXA Health really are brilliant. Give them a call, and they’ll talk you through the process step by step.

Quick info about arranging to see a private consultant for a diagnosis:

Ask your GP for an open referral letter.
Go to your Equipsme App or portal.
Call AXA Health on 0800 917 9472 or fill in the online form, to check your claim is eligible and start the process.
Have your membership number ready – you can find this in your App or portal, or by contacting Equipsme on 020 3965 6410.
If eligible, you’ll be able to arrange your private consultation with one of AXA Health’s approved hospitals and specialists/consultants.