Advisers are starting to encounter issues with private health clients being able to access appointments on open referral plans while there are signs customers do not understand how these arrangements work.
And practitioners are finding patients are being sent to doctors who do not specialise in the specific needs.
Private medical insurance (PMI) policies offering open referral or other directed treatment routes or limited consultant list products have been increasingly popular over the last two years due to their lower cost and the Financial Conduct Authority (FCA) has praised their use as an example of fair value.
However, speaking on the opening day of Health & Protection’s Health Summit, Insurance Boutique director Penny Jackson revealed issues were becoming an increasing problem.
“I’m getting a lot of frustration from clients. It’s obviously no-one else’s fault but mine that they can’t get that appointment with that specialist,” Jackson (pictured left) said.
“There is the problem that I have had some clients waiting up to two months before they could be seen.
“I was very pro-open referral in the beginning but now I’m starting to see more challenges because those consultants that are being referred to seem to have less availability.
“Some insurers like to call them their premier consultants. They’re not their premier consultants. They’re also supposed to be local and they’re not local, so they try to send people out on a 30-40 minute drive.
“I’ve also seen some cases where clients live in London and they’ve been sent to Hertfordshire so it’s a four hour round trip to see one of their premier consultants.
“So I think there is a problem there and I think it’s only going to get worse unfortunately.”
Not sent to right surgeon
Ahead of the panel session, Dr Richard Packard, chairman of the Federation of Independent Practitioner Organisations (FIPO), maintained that these issues mattered where patients considered it important that they were able to choose the doctor and hospital which will deliver their treatment.
“That is patently not something you can do if you’re on an open referral contract,” Packard continued.
“The problem is most people don’t know they’re on an open referral contract because most of the contracts are in corporate policies not in individual policies.
“And they don’t really find out what’s going on until they actually want to make a claim. And then they will go and talk to their insurer and they will be told in preauthorisation ‘oh we can send you to this doctor and this doctor and they will be able to look after you’.”
Packard further claimed that “an awful lot of the time” patients were not being sent to the right surgeon.
“It can be someone who happens to be an orthopaedic surgeon shall we say, but they do their orthopaedics on a different part of the body.
“They are people who do a bit of other things when their main interest is let’s say hips, they may do a bit of ankles, and they’re not necessarily an expert on it.
“So you’ve got to take all of these things into consideration.”
