Claiming on a Work Medical Plan

[AndWhenYouGetThere]

DP was in an accident in mid November and has broken his elbow. He managed to do it in a peculiar and complicated way which has meant the NHS docs (A & E and Orthopedics) have been postponing and forwarding him on to various different elbow experts since then (most with a 2-3 week wait between).

He's just had the results of another CT scan, which has led to another forward to a consultant which will take 6 weeks. And he's been unable to use that arm, which has fused solid, for over 8 weeks already.

He has an AXA PPP plan with his work, and the same specialist does do private care, but how on earth do we go about getting it? We are both young, in our first jobs out of uni, and so far, fairly inexperienced with healthcare issues (thankfully) so we're clueless!

To use AXA, then he needs to decide which consultant he wants to use, check AXA have them as a specialist, and that they will cover (and its well worth searching around for a really good elbow person as many general orthopaedic people will say they do elbows, but you need an arm specialist), then get his GP to write a referral letter.

AXA are super helpful in my experience of having a long running arm injury that they paid out over £10k in medical bills for, so just call them and they'll tell you just what to do.

When you say fused btw, do you mean his elbow doesn't flex/bend, or his forearm doesn't rotate?

Hi, thanks CMOT.

It turns out he's not registered with a GP where he lives (we're long distance and he recently moved). So that's our step 1 I guess.

Then he needs to get an appointment with the GP to forward him on -how would we go about finding a good elbow specialist? You're completely right, in my rudimentary googling, everyone's an expert on elbows. (I guess that's a salesperson technique.)

I've told him to call the AXA Health at Hand line - seems like that's the "way in" - they don't know about his accident yet (and there's an ongoing insurance debate which might confuse things somewhat) but it's definitely a start, thank you.

The elbow fusing issue is kind of both, the forearm rotation is very limited - I think due to pain, not physics, and he can't extend it beyond 90 degrees (pain and a horrible crunch). It's been in a sling, but no plaster, since the accident so to be honest the lack of movement isn't a surprise. I think his elecranon has gone into healing overdrive and just turned into a solid ball, not a joint.

Ah, thankyou NatashaBee too. That's encouraging. So once we get the GP sorted, the rest should flow quite simply, hopefully.

Will be reading the policy documents very carefully when he comes down at the weekend - hopefully should be one overnight stay and surgery, and then some ongoing physio (but physio could be NHS if we're not covered on the AXA).

Oh and apparently it's an Olecranon (the pointy bit on the end!)

We've had to use AXA insurance a few times and agree they are very helpful.

DH had to have some physio just recently, got a retrospective referral because it was so painful he couldn't wait to see GP, and last week we got a nice fat refund cheque from AXA. All covered!

I think there might be a limit on how many physio sessions he can have post-OP, depending on your cover, but AXA can talk you through it all.

My GP referred me to the Nuffield ENT consultant and (except for £100 excess) bupa picked up the bill. Very simple just the odd form to fill.

DH's work policy so I signed at the hospital that I could pay and he signed the odd letter from bupa, but it wasn't difficult.

I had my elbow joint released as an open procedure, and it was just an overnight stay, though often they do it as day case, two weeks in a jointed cast, and then physio. The surgery was pretty straightforward.
If you are W Midlands, I'd recommend my surgeon

Well, first steps partially completed. The lack of GP is our first hurdle, as he has to register for one near home, not near work - so will have to get some day time to pop in (no luck with online or phone registration apparently) But he's called AXA who were lovely and seem to know exactly what to do. Perfect for clue less younguns like us! So after the GP referral (to one of a top 5 elbow specialists in London - sadly not west mids, CMOT - that they've recommended) they will take it from there and organise everything with his work - nothing needed from us but to turn up and him to attempt his signature occasionally!
Thank you for your experience and reassurance - it's great to know we could get in touch with them now, before we have a treatment plan, consultants and bills - there's no way we could afford to pay first then claim, which is why we'd waited till now. Thanks so much