Bupa has revealed it is reviewing its fee model for consultants but private medical insurers across the market have declined to say how much they have changed fees for medical procedures.
Health & Protection reported in May that Axa Health had increased the fees it pays for medical procedures on average by 15% as some doctors were threatening to “decouple” from the insurer if it did not meet their higher self-pay rates.
Following this, Health & Protection approached other major health insurance providers about whether they had implemented any similar increases.
Every insurer said they regularly reviewed the fees they would pay for procedures, but Bupa was the only one to acknowledge it was reviewing its whole charging model for consultants.
None of those questioned were able to state as Axa Health had what level of increases had been either introduced or were under consideration.
Pressure has increasingly been coming from the medical profession onto insurers over the last two years to increase fees for procedures with some not changing for more than two decades.
This has been further tightened by the surge in demand for self-pay treatment for which fees are typically higher.
Aviva
Aviva told Health & Protection it does not apply a set increase but “reviews specialist fee remuneration at a procedure level as we believe this is fairer and a more accurate reflection of medical developments“.
“While the amount we will remunerate has increased for a number of procedures over recent years, there are some which have fallen due to advances in treatment enabling the procedure to be conducted more efficiently,“ it continued.
“The treatment of cataract is a prime example. Historically, most cataract treatments required a day-patient stay. Nowadays they are routinely treated as an out-patient. This has improved the patient experience and driven down the cost of the treatment.
“Exceptional cases are referred to a fee-uplift panel and decisions are based on the specific circumstances.“
Giving further detail, Aviva Health medical director Dr Suba M said: “As an insurer we have a responsibility to ensure our customers have access to a choice of specialist providers that are able to give appropriate care and to balance that with the need to keep private medical insurance affordable.
“In order to protect our customer outcomes Aviva carefully review and manage relationships with consultants including the setting of fees.
“We regularly review the appropriateness of our fees across all condition areas as well as having a process for individual cases.
“When setting fees we consider a range of factors including technical complexity, the duration of treatment, and risk factors relating to the patient and the nature of treatment.
“Value based healthcare remains at the forefront of our claims strategy as we believe this gives our customers the best possible outcome – to receive care tailored to their needs that is delivered efficiently.
“We’re focusing on initiatives such as clinical pathways, networks and our guiding strategy as we recognise the benefit they offer our customers on all levels.”
Bupa
A Bupa spokesperson said: “We’re in regular engagement with consultants. We’re currently reviewing our fee model to ensure our fees reflect consultants’ skills and expertise.”
National Friendly
National Friendly told Health & Protection that it periodically reviews its reasonable and customary fees guidelines for consultations and various treatments which are in the public domain.
“These are based upon what the majority of the consultants charge rather than us dictating what we will pay for a given service,“ it said.
“For clarity, by way of example, our current maximum guideline for an initial consultation is £250 with a follow-up consultation being £150.
“National Friendly is a mutual organisation where fairness is fundamental to our business model. The prices to our members reflect the underlying costs of the services we provide, and likewise for medical services the fees paid reflect the rates charged by the relevant health provider.
“As in any free market some providers in turn choose to offer varying discounts depending upon treatment type or frequency of treatment – but as noted above it is the medical provider setting the price not National Friendly.“
The insurer also noted that it saw two major factors influencing private medical treatment pricing:
- the location of the hospital, with those in more affluent areas intrinsically costing more to run;
- and the specific hospital group such as Ramsay, Circle, Spire, HCA, Nuffield and so on.
Vitality
Keith Klintworth, MD of VitalityHealth told Health & Protection: “We regularly review the fees we pay all consultants considering the type of service provided, the clinical outcomes delivered and the wider market we are operating in.
“A couple of years ago we created a new Premier Consultant panel, made up of consultants who are shown to deliver superior performance outcomes across 400 data points, and these now do the bulk of our procedures.
“We work closely with the panel on a range of factors, including costs and payments, and have committed to regularly reviewing fees paid and considering the impact of things such as inflation with them.”
WPA
WPA said it allows specialists to contract directly with their patients and bill what they think is appropriate as long as they are transparent in their pricing.
“The amount that WPA indemnifies is published in our regularly updated customary and reasonable fee schedule, which gives our customers the freedom to choose who is best placed to provide their healthcare based on several factors including whether the specialist charges will be fully covered,” said WPA corporate communications director Charlie MacEwan.
He added: “WPA’s published customary and reasonable fee schedule involves regular review of our fees by practicing specialists to ensure they reflect contemporary clinical practice and the time and skill involved.
“Our fees maxima remain more realistic than our competitors despite their recent rises.”