Equipsme how it all works: seeing a consultant for a diagnosis

If you’re looking at health benefits and insurance for your workforce for the first time, or if you’ve never come across a model like Equipsme before, it’s good to know how it all works in practice for the people at the sharp end – your workforce.

That’s why this guide shows how to use an Equipsme plan in real life, step-by-step.

A bit about us

Hi. We’re Equipsme. We thought health benefits and insurance should be better, and work for more people, so we built something different. We’re backed by AXA Health, so you know you’re in safe hands and getting the best care. We’ve just made it more affordable and more accessible.

At Equipsme, we LOVE the NHS - but there’s no pretending it isn’t under enormous pressure right now. Your Equipsme plan is here as your back-up plan, helping you beat the queues and get back to being fighting (and working) fit as soon as possible.

Unlike other health benefits and insurance, we actually want people to USE their plan. It’s not supposed to sit in your back pocket and do nothing. Which is exactly why we’ve put together these practical guides.

It’s great to have GP support, but sometimes you need to see a specialist consultant to figure out what’s going on and what to do about it. If your plan includes diagnosis cover (all levels except GP+) and your claim is eligible (ie, not a pre-existing or chronic condition or otherwise excluded) the Equipsme plan can help cut your waiting time by weeks or even months.

Help. My GP says I need to see a consultant. 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 consultant 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 24/7 GP. If you use our GP service and they recommend you see a specialist, HealthHero will email you a copy of the open referral letter. AXA Health will assess whether your condition is eligible for cover under the Equipsme plan and if authorised, AXA Health will help you make an appointment with one of their recognised specialists or a hospital/clinic for treatment.

If the condition you are claiming for might be pre-existing, you may need to obtain additional information from your own GP first (as only they can access your medical history records).

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

  1. Go to your app or login to the Members portal on the Equipsme website.
  2. If diagnosis is part of your plan, it will appear as an icon on your page. Click on the Diagnosis Cover icon.
  3. Your diagnosis cover is provided by AXA Health, so you know you’re in the best hands. Call them direct to talk through your cover, and your appointment options. You can also fill in an online form.
  4. You’ll need your Equipsme plan number and your AXA Health membership number when speaking to AXA Health, which are on the screen to help you. All our forms will be prepopulated with these details.

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 offer you a number of specialists or hospitals from their nationwide network, which includes BMI Healthcare, Nuffield Health and Spire Healthcare hospitals. They’ll also help you choose a consultant from their list of those who specialise in the medical area you need.

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

How do I know what consultant to choose?

Think of AXA Health’s registered consultants 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 cover that you can use at the hospital. If your Equipsme plan Level includes an excess, you will have to settle directly with the provider but otherwise you won’t be asked for any money when you get there – just your claim authorisation number!

What about my excess?

Some Equipmse plans have an excess. This is the amount you have to pay yourself before your cover kicks in and is usually £150 per plan year. You will usually receive an invoice for settlement from the treatment provider, for you to settle direct.

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 helps you skip some of these queues.

It’s also worth noting that not all medical conditions will be covered by your Equipsme plan. For example, we can’t cover treatment of chronic/long-term conditions or pre-existing conditions (meaning something you’ve had symptoms, medical advice or treatment for in the three years before you cover starts).

Once you are on cover with us, you’ll receive full details of what is and isn’t covered in your membership handbook. Or you can download our summary How To Use Your Plan guide here to find out more now.

I’m still not sure how it all works!

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