What is Diagnosis and Treatment?

What is Diagnosis and Treatment?

24 Sep 2020

At Equipsme, it’s always been our aim to open up health insurance to people who didn’t think they’d ever have health insurance.

That means for lots of members it’s the first time they’ve had a plan – and that’s why we talk in plain English, and we try and leave out both insurance and medical jargon.

But there’s some terms that just ARE. Diagnosis and treatment are two of them.

What is Diagnosis?

Everyone knows that a Dr assesses them and then makes a ‘diagnosis’ of what’s wrong with them, and what needs doing next to fix it. But in health insurance terms if you’ve got Diagnosis as part of your plan it means you can access specialists and consultants privately.

In turn, that means you’re going to get to see the right person much faster, and get your diagnosis faster too. For serious conditions speed can be of the essence, and private diagnosis can help you skip ahead - particularly if there’s a long queue to see the right kind of specialist on the NHS.

How does it work?

If you’ve been to a GP with symptoms, whether that’s your own GP or one of Equipsme’s 24/7 GPs, they may refer you to see a specialist. In order to see a specialist privately under your plan, you’ll need what’s called an ‘open referral’ letter. This is from the GP, detailing what the issue is and what type of medical specialist you need to see.

You then need to log into your Equipsme portal, where you’ll find your plan membership details and a number to call AXA PPP healthcare, the insurance partners that provide this bit of your Equipsme cover. A personal advisor will talk you through the next steps, confirm if your condition is covered and get everything arranged for you. If it’s not convenient for you to call, you can submit an online claim form and the team at AXA PPP healthcare will get back to you.

AXA PPP healthcare use a nationwide network of hospitals and specialists, including BMI, Nuffield, Spire and other independent private hospitals, which means most of our members find they live or work within 15 miles of a provider – and just 5 miles in London. You’ll be offered a choice of appointments near you, at times to suit you. There’s nothing to pay up front (unless your plan includes an excess), and once you’re booked in you just turn up at the right time and place - and see the right consultant for you.

What’s included?

  • Consultations with the right specialist
  • No yearly limit on appointments, or how many ailments or illnesses you have
  • Diagnostic tests, including blood tests
  • MRI scans, CT scans and X-rays
  • Approved medical costs will be settled directly, so you’re not forking out first and waiting to be paid back like a cash plan
  • No excess to pay, or a small £150 excess depending on your type of plan.
  • No shortfalls on diagnostics booked by AXA PPP healthcare so no shocks after seeing someone

What’s not included?

  • Any pre-existing condition you’ve had symptoms, medication or treatment for in the last three years
  • Anything that’s not a medical necessity
  • We also don’t cover fertility treatment, or mental health care.
  • Long term, ongoing, chronic conditions – like Crohn’s disease

Basically if it’s new, if it’s medically necessary, and if you’ve arranged it through AXA PPP healthcare first, you’re covered.

What is Treatment?

Clearly Treatment is, well, the treatment of what you’ve been diagnosed with. Some plans include Diagnosis only, which means once you’ve been diagnosed you’ll be referred back to the NHS for whatever operations, medicines, or therapies you’ll need to get better or manage your condition. If you have Diagnosis AND Treatment on your plan, that can be done privately.

How does it work?

If you’ve had a diagnosis, either from your GP or from a consultant under your Diagnosis cover, you can call up AXA PPP healthcare and they’ll confirm if your private treatment is covered and help arrange it for you. A personal advisor will find the right location, person, and time slot to suit you.

What’s included?

  • Private Hospital treatment
  • Your hospital room, and stay, including nursing care
  • Specialists and surgeons and their teams
  • Drugs and dressings used during surgery
  • Approved medical costs will be settled directly, so you’re not paying out up front
  • No excess to pay, or a small £150 excess depending on your plan.

What’s not included?

  • Any pre-existing condition you’ve had symptoms for in the last three years
  • Long term, ongoing, chronic conditions – like Crohn’s disease
  • Anything that’s not a medical necessity
  • We don’t cover pregnancy care, although we do cover some complications that can arise from pregnancy and require treatment
  • We don’t cover fertility treatment or mental health care
  • We don’t cover cancer treatment, but we do cover up to diagnosis to speed things up

The NHS is best placed to deal holistically with cancer patients, and we guide people back into the system for their treatment. It means we can keep premiums low and get more people better access to more general healthcare that compliments and relieves pressure from the NHS elsewhere. With cancer, so often it is the speed of diagnosis that can most impact the treatment and outcome that’s needed. That bit IS covered under your Diagnosis benefit.

Diagnosis and Treatment is about speed, convenience, and peace of mind. It’s about getting to the right person and getting sorted out fast, so you can get on with the rest of your life.

For a full list of exclusions please refer to your Equipsme plan documents, which can also be found on your Equipsme portal.