Bupa has made a series of concessions to medical practioners including increasing fees, the launch of a consultant panel and a commitment to regularly reviewing fees in future.
It is also reviewing its private medical insurance (PMI) benefit limits.
Bupa will increase fees for anaesthetists by between 10% and 28% and for surgeons by 10% and 23% for procedures taking place from Friday 1 November, with the simplest fees rising by just £12 for surgeons and £21 for anaesthetists.
In July, Health & Protection exclusively revealed that Bupa was reviewing its fee model for consultants, while in May Health & Protection also revealed that Axa Health had increased the fees it pays for medical procedures on average by 15%.
Last month the Independent Doctors Federation (IDF) launched a campaign to rebalance the relationship between doctors and insurers as part of the long-running dispute between the parties over fees, patient care and other medical processes.
However, the IDF has rejected this latest move by Bupa, saying it does not come closes to rebalancing fees which have been unchanged since the late 1990s.
Bupa’s communication commits to:
- an increase in fees for both anaesthetic and surgical procedure fees for treatment from next month;
- the confirmation of a benefits limits review;
- a speedier uplift process to make it easier for consultants to claim fair reimbursement in more complex cases which reduces the average time for a response to less than five days;
- a commitment to review fees regularly using Bupa’s revised model and to consider the evolution of care and the delivery of treatment in future reviews.
Anaesthetic and surgical fees
According to the email, anaesthetic procedure fees for treatment that takes place from 1 November will increase by between 10% and 28% depending on the complexity rating of the procedure.
This includes the minimum 5% anaesthetic procedure fee increase Bupa committed to introduce in November 2024 and is in addition to the 15% fee increase it introduced last year.
The fee increases apply to both Bupa UK Insurance and Bupa Global patients.
For example, the fee for the least complex and most minor treatments will rise from £117 to £138, while fees for the most complex and serious procedures will rise from £1,208 to £1,425.
Surgical procedure fees for treatment which takes place from 1 November 2024 will also increase by between 5% and 23% depending on the complexity rating of the procedure.
This is in addition to the minimum 7% consultation fee increases for contracted consultants Bupa introduced in December 2023.
For example, the fee for the least complex and most minor treatments will rise from £91 to £103, while fees for the most complex and serious procedures will rise from £2,030 to £2,172.
Bupa said it had derived a new formula for fee levels following consultation with Curzon Consulting. This is:
[Clinical time x Hourly rate x Technical factor] + Average indemnity cost per patient + Average admin cost per patient
However, it added that hospitals will continue to cover the cost of assistant surgeons and where a second operating surgeon is required, its benefit limits will continue to be chargeable.
Bupa further added that anaesthetic and surgical procedure fees have not been reduced.
Billing processes
The insurer also noted billing processes will remain the same with it updating the schedule of procedures with the new rates from 1 November, and all consultants need do is charge the increased fees for treatment.
Bupa also said that it will continue to not charge for invoices submitted via providers online and that its uplift process for complex cases is now quicker with an average turnaround of less than five days.
And it is establishing a new consultant panel which will build on input that consultants have provided this year and to seek more guidance in the future.
Bupa Benefits Limits Review
In its email Bupa further revealed that when it increased anaesthetic procedure fees in November 2023, it committed to carrying out a detailed review of its procedure fees.
The insurer said the key themes raised from the research conducted by Curzon Consulting included:
- Health insurance fee models need to more accurately reflect the clinical time required for each procedure more time needed to prepare due to changes in patient complexity and demands.
- Health insurance fee structures are static despite rising operating costs such as indemnity insurance and practice running costs.
- Health insurance fee calculations aren’t transparent.
- Health insurance fees do not always account for complexity patients today are older, with considerably greater health issues than 20 years ago.
- Fee structures do not always account for the extra skill and time needed to complete the treatment.
As a result, Bupa said this review ensures its fee model is “fair, independent and transparent, more accurately representing consultant effort and costs”.
It said the review was based on external input which it received for 95% of all codes and ensures consultants are remunerated based on the complexity and the average time worked per procedure.
The insurer said it has used this input to inform the fee increases for all codes in its schedule.
The review also considers highly specialised procedures, average indemnity premiums per specialism per patient seen and administrative costs.
Bupa acknowledged the “invaluable” input and feedback from professional organisations such as the Association of Anaesthetists, British Medical Association and the Independent Doctors Federation as well as more than 200 consultants across various specialties who took the time to share their insights.
It added it is “committed to the ongoing review of our model and will seek continued engagement to make future improvements”.
But for its part, the IDF has since released a statement expressing its concern that it has been listed as a contributor to this review, and adding that it was “neither consulted on nor given insight into the methodology, outcomes, or impending fee changes associated with this review prior to its publication”.
Further action
Recognising consultant feedback that they are seeing increasing numbers of patients with comorbidities and routine surgery which can be “anything but routine”, Bupa said it had speeded up its uplift process to make it easier for consultants to claim fair reimbursement in these cases – reducing the average response time to less than five days.
Looking ahead, Bupa committed to regularly reviewing its fees using its improved model and considering the evolution of care and the delivery of treatment in future reviews.
It will continue dialogue with consultant representative bodies, adding it is committed to maintaining an ongoing, transparent dialogue with individual consultants.
It also plans to host regular question and answer sessions and establish a consultant panel to build on input consultants have provided this year and to seek more input from them.
It further committed to reviewing feedback received from its recent consultant survey, such as how it can improve terminology around recognition for consultants and its customers.
It said it will work with consultants and administrative support teams to make Bupa easier to work with.
Health & Protection has approached Bupa for comment.