Private doctors have revealed the overwhelming state of their severe dissatisfaction and frustration at private medical insurers and their treatment decisions, derecognition processes and fees paid.
Research carried out by the Independent Doctors’ Federation (IDF) produced stark results which included
- 99% of respondents being unhappy with insurers assured fees,
- 97% feeling there was not a clear and transparent appeals process following derecognition and
- 84% feeling patients sometimes receive a lower standard of treatment than they expected.
The IDF represents more than 1,550 doctors working in private practice across the UK including specialists and general practitioners, and received responses from 474 members for its research.
Health & Protection has contacted the three insurers named directly by medical professionals in the research, Axa Health, Bupa and Vitality, along with the Association of British Insurers (ABI) to offer the opportunity to respond fully to the issues raised by the IDF
Fairness of fees
Independent doctors overwhelming do not think fees paid by private medical insurers are fair.
When asked how much the costs of operating their practice or providing services had increased over the last five years, 74% said costs had grown by more than 20%.
But a stunning 99.2% felt private medical insurer assured fees did not represent a fair reimbursement for the provision of services and care they provide.
The research also indicated resistance among insurers to even broach the thorny subject of fees, with 73% of doctors claiming insurers had ignored requests to renegotiate them.
Meanwhile 84% said they did not think insurers recognised the additional clinical value of certain medical specialties in the size of fees they approved.
Affecting treatment options
However their ire is not limited to just the value of fees, with respondents believing insurers were affecting the care being offered to patients.
Doctors claimed that insurer assured fees were affecting their ability to do their job – 84% of respondents claimed these fees had impeded the patient-doctor partnership in assessing their care needs and treating them in line with their clinical judgment.
A similar percentage (83%) also felt insurers had provided or declined certain treatment options based on their own guidance as opposed to established best practice guidance.
And 84% said patients sometimes received a lower standard of quality or amount of treatment than they expected through insurance.
Furthermore two thirds (66%) felt insurers had recommended a patient first be placed on a wrong or inappropriate treatment pathway.
Significant minority also argued patient care quality had been affected.
One in six (17%) practitioners said getting the most suitable treatment had been delayed due to insurers’ influence of treatment decisions or fee setting, while 27% said a patient had been unable to receive treatment through their insurer and their condition worsened as a result.
Doctors also pointed to frustrations with PMI policies limiting their ability to do their job, with 72% of those polled claiming the policies constrained them from referring to other independent healthcare providers or specialists such as surgeons.
Threat of derecognition
And the research also showed that 55% of doctors surveyed had been threatened with derecognition by a private medical insurer with a quarter reporting that an insurer had followed through with this threat.
When asked about the justification for being derecognised, 68% said it was due to a disagreement over fees.
The general feeling cited among respondents was that it was about working with derecognised specialists or due to costs being too high or that there was too much activity.
Notably, across the whole body of respondents, there was near-unanimous criticism of the appeals process.
Practically all respondents (97%) did not feel that there was a clear and transparent appeals process following derecognition by insurers.