Medical Diagnostics - tests including scans

You'll be responsible for funding any unauthorised diagnostic costs, or any incurred costs over £2,500. To help manage these costs, you should request that the consultant and facility where you have your appointment provide you with a guide price which includes all associated fees. You must contact us for authorisation before you proceed with any appointments.

Please note we will not provide funding if you proceed with any appointments without our authorisation.

We won’t currently authorise diagnostic assistance for:

• Any appointments which are not for diagnosis purposes.
• Cosmetic concerns.
• Angiograms (cardiac catheterisation).
• Specialist assistance for pain management.
• Complementary therapy.
• Second opinion consultations.
• Any diagnosis where, in our view, it may be safer for you to remain on the NHS waiting list e.g. psychiatry and suspected cancer diagnosis or where the diagnosis may lead to a long-term medical requirement.

The above list is subject to change and you should always contact us for authorisation prior to making any appointments.

• All appointments we authorise must take place within six months of our initial authorisation.

• We won’t settle any expense that you incur more than six months after initial authorisation.

• We won’t pay for services relating to the same medical condition on the same body area within two years of us first authorising support.

• We’ll only authorise Physiotherapy, Medical Diagnostics or Medical Treatment assistance for one set of health concerns at any one time.

• We won’t pay for monitoring of any ongoing condition, including consultations or treatment.

• We’re unable to pay for any diagnostic services if you’re not a UK resident.

• You should always contact us before arranging any appointments to find out whether we can help you.

NHS wait times will be considered before authorising any diagnostics services and are subject to change. Please refer to our guidance on how NHS waiting times may determine whether your request will be authorised.

What should I do if I can't get an appointment to see my own GP for a referral? 

• We take referrals from any qualified NHS practitioner, so you can request to see another practitioner in your surgery.

I have been to see my GP, but I can't get another appointment to get my referral, what do I do?

• If you’ve been referred, you don't need another appointment. You just need to call your surgery and ask for a copy of the referral or, alternatively, you may be able to find it on your NHS app.

My GP wants to charge me for the referral, what do I do?

• If you’ve been referred to the NHS, we just need a copy of that referral, nothing more. There should not be a charge for NHS referrals. The practitioner may be thinking that you want a private referral, but this is not the case. Please note that, unfortunately, we can’t reimburse the cost of private referral letters.

Why can’t you accept a referral from my Optician?

• We currently only accept optician referrals for cataracts, as all opticians can refer their patients into NHS ophthalmic services for cataract procedures. All opticians are private businesses that may have contracted agreements with their local NHS services. For those patients who require referral for other eye conditions, i.e., macular degeneration/retinopathies etc., in many localities the optician can’t directly refer into the NHS, as there hasn’t been a contract agreed.

Can you accept a referral / discharge form from A & E?

• Yes, we now accept these.

Can you accept a referral from my Physiotherapist?

• We can accept any referral as long as the referral is from a qualified NHS practitioner with the correct qualification and you’ve seen them through an NHS appointment.

Can you accept a referral from my Dentist?

• No, unfortunately, we can’t accept referrals from your dentist. Many dentists don’t have contracted agreements to refer directly into NHS secondary care services and, therefore, you’ll need to use your GP to provide that NHS referral.

Can you accept referrals from NHS Radiologists?

• Yes, we can accept referrals from NHS Radiologists.

Can you accept a screenshot of a member’s NHS referral from their NHS App? 

• We need details of your full medical history contained within your referral that you may not be able to capture with your screen shot. You should be able to download your referral from the NHS app and send it to us as an e-mail attachment.