Axa Health has increased the fees it pays for medical procedures by 15% as some doctors are threatening to “decouple” from the insurer if it does not meet their higher self-pay rates.
Sarah Taylor, head of specialist and practitioner strategy at Axa Health, admitted some of the fees previously paid were “woeful” as she revealed insurers had kept fees “artificially low”.
Noting that she was not necessarily speaking on behalf of Axa Health, she said: “We have kept doctors’ fees low – artificially low.”
Taylor added doctors were demanding pay reflect their experience and the potentially life-threatening situations they work in, and calling for fees to be index-linked while threatening to abandon working with the insurer.
Taylor (pictured) was speaking at the Association of Medical Insurers and Intermediaries (AMII) Spring Health and Wellbeing Summit and AGM.
Revealing the insurer had raised its published fees paid for medical procedures, Taylor said: “I don’t know if you know, but we put up our published fees by 15% because frankly it was a bit woeful.”
Speaking about a particular procedure, Taylor said: “We paid £145, and they’ve done seven years of medical school.”
She noted these were consultants in their late 30s while “a man that comes into clean my cooker gets £120.”
“So we’ve really got to start to think about that – reset in our minds about what the costs are going to have to be, because that is the reality.“
Explaining how the strength of the self-pay market was also driving the agenda, she continued: “Doctors can command pretty much their own fees for self-pay patients.
“We are now daily getting specialists coming to us saying: ‘You’re only going to pay me £145 in your new published fees. Thank you very much by the way for putting the fees up, but I can get £295 for self-pay patients.’
“The maths doesn’t stack up, so the self-pay market is really leading to a challenge for us.”
She said following the pandemic and with the view that the NHS is failing, people’s mindset has changed and if they have savings they are willing to self-pay.
“So the likelihood of people doing it and the control that those clinicians have over their fees is far, far greater.”
As a result the attitude of the clinicians has hardened significantly.
She said clinicians are saying: “I expect you to pay me what I’m getting from self-pay patients and if you don’t pay me what I’m getting for self-paying patients, I will decouple.”
Taylor highlighted this as an interesting word to use as “they were basically saying ‘I will go through with it’ – which is a real problem.”
‘Kept fees artificially low’
Taylor said to avoid fees being depressed for the next 20 years specialists now want index linked fees, and want to be recognised for their seniority as well.
“And they’ve got a point,” she continued.
“So we are now going to have to build into the ongoing costs and the lift up to recognise that and start to be a bit more flexible about how we reward those clinicians that are providing care to others privately.“
Taylor also stated that fees for doctors have been kept too low.
“And what ends up happening is they then say I’m going to add on another consultation, I’m going to do a little bit more, because it’s a fee for service.
“They are not exactly the poorest in the country, but they are facing some of the similar issues around cost of living.
“So fee for service is a poor thing, and I think we need to really think about that as we go forward and emerge from what has been a real shot to the bow.”
She added: “We are no longer the biggest dog in the game.”
Life-threatening situations
A discussion with a colorectal surgeon in London demonstrated the extent of the problem, as the surgeon told her £700 for a hemiclectomy where a patient could potentially die was not enough.
She said: “We’ve also started to look at some of the really complex work. Patients are becoming more complex. They’re getting sicker, they’re fatter. We’re seeing more complex work taking place in the private sector.
“So having sat down with a colorectal surgeon in London who said – ‘your payment is £700 for a hemiclectomy where I could kill the patient – £700 where you could kill the patient, That patient is admitted for a few days and you go to bed the night before feeling sick.’
“And that’s how he described it.
“So we’ve started to add in that fear factor, and the fact that they are on call.”
Cannot be the evil insurer
The end result is that insurers can no longer dictate their fees on a take it or leave it basis, Taylor maintained.
“We cannot sit here as the evil insurer and just tell them what to do, we’ve got to engage with them in a better way,” she continued.
“We’ve really got to start to think about that – reset in our minds about what the costs are going to have to be, because that’s the reality.
“We’ve got less people wanting to go into private healthcare [to work]. We’ve got more challenges.
“So we’ve all got to work together to see how we’re going to resolve that.
“So that comment about beating the insurer to get the lowest price – we are trying to do the right thing, it’s just the lowest price might not be as low as it used to be.“
Axa Health’s move is the latest in a long-running dispute between medical practitioners and insurers over the fees paid for procedures.
Health & Protection reported a deepening rift between private doctors and insurers late last year. Private doctors were reported to be beginning a campaign against private medical insurance (PMI) providers over the growing control they argue insurers have in the market.
In March last year, Federation of Independent Practitioner Organisations (FIPO) chairman Dr Richard Packard told the Health & Protection Health Summit that PMI would become less attractive to doctors “if relations between private medical insurers and consultants do not improve”, particularly where fees were concerned.
In October 2022 Independent Doctors Federation consultant orthopaedic surgeon Susan Alexander argued that for some procedures insurers were paying less than they had in 1999.
She contended that it was increasingly difficult to maintain service quality and that there was no reward for experience and expertise, with consultants becoming increasingly angry.
‘Increased fees proportionately and fairly’
After the conference, Health & Protection approached Axa Health for an official response.
In a further statement, Taylor said: “The view from many consultants and others in the healthcare industry is that some specialist fees were too low and needed to better reflect changing circumstances and pressures.
“Axa Health recognised this and last year increased fees proportionately and fairly for those specialists.
“We continue to adjust our fees in light of market circumstances and seek to keep specialists updated and informed regarding any changes.
“We want to provide safe, effective care for our members. We aim to provide value for our customers but also ensure our fees and terms are fair to specialists.
“It’s essential that we work constructively with specialists to ensure we have a two-way dialogue and that we’re able to listen and react appropriately so we can continue to provide great care for our members.”