Health Insurance Guides
Are screening and diagnostic tests covered by health insurance?
Key takeaways: Are screening and diagnostic tests covered by health insurance?
Most private health insurers cover diagnostic tests and scans, but they don’t usually cover routine screening. You’ll usually need a referral from a specialist, and you’ll need your insurer to ‘pre-authorise’ the test or scan before you have it.
You won’t usually be covered for tests or scans for conditions you had symptoms of before your cover started. Depending on the insurer, there may be limits on the number of tests or scans you can have, and you may need to have them at a hospital your insurer sources.
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Jump to sections:
- Are screening and diagnostic tests covered by health insurance?
- What’s the difference between screening and diagnostic tests and scans?
- How do health insurers cover diagnostic tests and scans?
- When are diagnostic tests and scans not covered by private health insurance?
- How will I know what diagnostic tests and scans my health insurance covers?
Are screening and diagnostic tests covered by health insurance?
Having diagnostic tests and scans privately can help you find out if something is wrong quickly. Most private health insurers cover diagnostic tests and scans, but they don’t usually cover routine medical screening.
Private health insurers will usually cover diagnostic tests if a specialist refers you. However, the way they cover it will vary depending on the insurer and your individual plan.
Health insurance doesn’t usually cover medical screening when you don’t already have symptoms. For example, health insurers won’t usually cover any of the following when you don’t already have symptoms:
- mammograms or other screening checks for breast cancer
- cervical ‘smear’ tests
- PSA tests for prostate cancer
- colonoscopy or stool tests for bowel cancer
- skin cancer checks
- bone density (DEXA) scans
- tests for infectious diseases
- genetic tests to see if you’re at risk for a disease, such as cancer
- annual checkups.
This is because private medical insurance is designed to cover the diagnosis and treatment of new and unexpected medical conditions that start after your plan starts, not preventative treatment.
However, some insurers will give you free or discounted access to some health assessments or simple tests, such as blood tests you can carry out yourself at home.
What’s the difference between screening and diagnostic tests and scans?
Screening
Screening tests are usually used for early detection of diseases or to identify risk factors. The NHS runs several screening programmes, such as:
- bowel cancer screening for everyone aged 54 to 74
- breast cancer screening for women aged 50 to 70
- cervical screening for women aged 25 to 64
- extra screening checks, such as eye health, for people with diabetes.
You may get an invitation to take part in screening when you reach a certain age or life stage, or if you’re considered to be at a higher risk of developing the disease. You don’t need to have any symptoms to be invited to take part in screening. If screening identifies potential issues, you might then be referred for further tests.
You can pay for private screening tests. However, it’s worth researching these to check whether the benefits outweigh the harms. The government has guidance on commercial screening tests.
Diagnostic tests and scans
Diagnostic tests and scans are used to confirm a diagnosis or investigate symptoms. You’ll often have symptoms and need a referral from a GP or specialist before you can have a diagnostic test or scan.
Diagnostic tests and scans include:
- Blood tests
- X-rays
- Ultrasound scans
- Biopsies
- CT, MRI and PET scans
You could have the test or scan as an outpatient, day patient (where you need a medical professional to look after you after the test), or as an inpatient (where you stay overnight).
How do health insurers cover diagnostic tests and scans?
Some insurers include diagnostic tests and scans in their core cover. With others you may have to pay extra to add them as a separate option.
The number of diagnostic tests and scans you can claim for on your health insurance may vary depending on your insurer, and you may have to have the test or scan at a hospital or scanning centre your insurer sources for you. Your health insurer may only cover a test if your specialist refers you (not if your GP refers you).
You’ll usually need to get in touch with your health insurer before you have the test or scan so they can check your plan covers it. This is called ‘pre-authorisation’.
With AXA Health, if you choose to add our Outpatient diagnosis and care option you’ll get as many scans and tests as you need, so long as a specialist refers you. If you’ve chosen our Inpatient and day patient option, you’ll be covered for diagnostic tests and scans you have as an inpatient or day patient.
When are diagnostic tests and scans not covered by private health insurance?
The tests that your insurer covers will depend on your individual insurer and plan, so check with your insurer before you have the test or scan.
It’s also worth bearing the following in mind:
- If your GP refers you for a test or scan directly, you won’t usually be covered. Most health insurers only cover diagnostic tests and scans if you’re referred by a specialist.
- With some insurers, the specialists and hospitals or clinics you can use may depend on your plan. If you have the test or scan somewhere else, you may not be covered.
- Health insurance is designed to cover new conditions, so tests or scans for conditions you have symptoms of when your health insurance starts – whether you’ve seen a doctor or not – aren’t usually covered.
- With some insurers and plans, there may be limits on the number of outpatient consultations you can have. Diagnostic tests and scans may count towards this limit. If you’ve already reached the limit, you’ll need to cover the cost yourself or have the test or scan on the NHS.
- Most insurers don’t usually cover tests and scans that are part of routine pregnancy and maternity care.
- There may be other tests and scans your health insurer doesn’t cover. You’ll find details of these in your plan’s handbook or other documents.
How will I know what diagnostic tests and scans my health insurance covers?
Your membership documents will tell you what you’re covered for.
You’ll usually need to contact your health insurer about the tests before you have them. They’ll be able to tell you if you’re covered, and will give you the information you need to have the test or scan.