What is a diagnostic endoscopy?
Diagnostic endoscopy is a procedure carried out by doctors to examine a patient’s internal organs in order to investigate clinical conditions or symptoms and make a diagnosis. An endoscope, which is a long, thin, tube-like instrument with a camera and light at its tip, is used for the procedure.
For example, diagnostic endoscopy can be used to:
- determine possible causes of rectal bleeding, chronic abdominal pain, and/or chronic diarrhoea
- collect a tissue sample (biopsy) from abnormal part/s inside the stomach, intestines, nose or throat for laboratory examination of possible cancer/benign tumour/inflammation
Are diagnostic endoscopies covered under MyShield plan?
MyShield plan covers diagnostic endoscopies as part of the plan’s coverage of day surgeries as long as the endoscopy is medically necessary. That is, the endoscopy recommended by the doctor is consistent with the symptoms, diagnosis and treatment of a patient’s condition, based on accepted standards of good medical practice in the community.
Endoscopies that are not medically necessary will not be covered. For example, if a patient only has upper gastro intestinal tract symptoms, such as gastric pain, or oesophageal regurgitation, which a doctor suspects is due to gastroesophageal reflux disease (GERD/Gastritis), but the patient was admitted to the hospital for both gastroscopy and colonoscopy, the colonoscopy would not be covered. That’s because it is not related to the patient’s medical condition and hence not a medically necessary procedure to treat GERD.
What about other diagnostics?
MyShield plan also covers diagnostic procedures other than endoscopies as long as the procedures are medically necessary.
Other diagnostics (not surgical procedures), such as x-rays, MRIs or laboratory tests, are covered if the patient subsequently requires medical or surgical treatment in a hospital, or if they are part of pre- or post-hospitalisation management of the medical condition which requires inpatient treatment or hospitalisation.
If performed as standalone outpatient tests, however, they won’t be covered, as the purpose of an Integrated Shield Plan is to cover large surgical and hospitalisation bills.
Diagnostics performed as part of annual health screenings are also not covered.
Tips for a successful claim on your policy
To enjoy greater peace of mind and certainty of claims, we encourage MyShield policyholders to use the service of an Aviva panel specialist and obtain a Certificate of Pre-Authorisation from Aviva before undergoing any planned medical treatment or hospitalisation.
You can ask your doctor to submit the Pre-Authorisation Request Form for you or, if you prefer to handle it personally, you can call Aviva’s 24/7 hotline at 1800 8800 880 to submit the necessary documents. Click here for more details on pre-authorisation of claims.