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BUPA insurance - really value for money?
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# 1
dizzie
Old 01-05-2012, 11:10 PM
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Default BUPA insurance - really value for money?

We have held a family BUPA health insurance for the last 10 years, but in light of recent developments, I am about to make a move away from this insurer for the following reasons:

1. Our health insurance premiums rise each year by an amount that massively outstrips inflation. Okay, I realise that as we age, we become a greater health risk to insure, but I feel that the increases go beyond this.

2. BUPA have recently claimed that the cost of providing cover is increasing. They claim that they need to curb costs. They are doing this in the following way:

They are trying to introduce an "open referral" system. This means that your GP will be unable to refer you to the person he or she thinks has a particular expertise for the condition you are suffering with. Instead, they will only be able to refer in a "generic" style - e.g. to "an orthopaedic surgeon". BUPA will select the consultant or give a limited choice of who you are allowed to see. Undoubtedly, BUPA will provide that choice based largely on economics (except perhaps where they stand to gain by providing both the insurance and the treatment - i.e. in their BUPA Health and Wellbeing Centres).

In essence, this means that if you need a hip replacement - and the most experienced hip specialist in your area is not on their limited list, you'll end up seeing someone else.....but who?

...well, in order to gain consultant recognition in recent years, BUPA have made new consultants sign up to a contract where they are unable to charge more than BUPA tell them they can have. So economically speaking, it will be in BUPA's interest to refer you on to a new and somewhat less experienced surgeon....or perhaps someone who is more of a generalist rather than one who has particular expertise in hip surgery!

You might consider that this serves the more experienced consultant right for charging more...but here are the shocking facts:

BUPA, like all insurers print a schedule of procedures which details what they are prepared to pay for each procedure. Those limits have NOT RISEN since 1992 - yes, that's a 20 year pay-freeze! During this time however, inflation has risen as well as overheads such as medical indemnity premiums! Furthermore this week, BUPA have unveiled their new schedule of procedures and have now downgraded the amounts payable for many procedures. Some limits have been reduced by over 45%. For example, if your consultant wants you to return for a follow up consultation at which he also wishes to give you a soft tissue injection - then BUPA will only reimburse the doctor 50 for this (down from 91). The consultant would be better just charging you for a follow up consultation and not mentioning the injection...but of course that will erode your outpatient benefit limit. Frankly, I am shocked by this. It costs me about the same (i.e. 50) to visit my hairdresser!

These reductions will either force more consultants off their books (further limiting choice for patients) or it will leave patients having to part fund their treatment because the insurer reimbursement will be less ( I am informed that the latter will be the case where patients are seen at BUPA Health and Wellbeing Centres where fees will not be reduced but where patients will still be allowed to be referred - footing the difference themselves!).

If the costs of providing cover are rising, then it is not individual doctors to blame. Private hospital charges tend to form the bulk of the amounts that insurers pay out and in my opinion, this is where costs should be being controlled.

How can BUPA do this to policyholders? Well, between them and AXA PPP, they have 70% of the healthcare market so they think they have the power to do what they want! I should say that such sharp practice is not being implemented by the smaller insurers such as WPA or Pru Health and in the interests of fair competition, it is perhaps about time that we compared the likes of BUPA with these smaller insurers.

So as my renewal date draws near, I am looking into other quotes and those I have received so far are actually cheaper than BUPA. But for me, the important thing is that I can rest assured that with another insurer, I will see the specialist who is right for my needs without being left massively out of pocket.

Last edited by dizzie; 01-05-2012 at 11:27 PM.
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# 2
dizzie
Old 03-05-2012, 9:36 PM
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Thanks PPF, I'll "google" that. The interesting thing is that the open referral system is claimed to work on GPs referring patients for a procedure! But GPs are generalists and are not qualified to say what clinical procedure is necessary (in all but the most straightforward of cases). More often than not, patients are referred for an expert clinical opinion by their GP (i.e. for an initial consultation, rather than a specific procedure). It is the expert consultant that then discusses the options and recommends the most appropriate procedure (after having taken into account the clinical history and any examination /investigation findings).

On the basis of this - will the system work as follows:

GP refers for initial consultation to well established local consultant who is known to have particular expertise in a certain field.....then.... Consultant sees patient and recommends procedure to GP.....then.... GP/first consultant has to allow insurer to "outsource" the provision of that procedure with a cheaper consultant.

If this is the case, that is undesirable because during initial consultation, the patient gets to ask questions, seek reassurance/advice and start to build a relationship of trust with that doctor. Then, they could be palmed off to have the procedure performed by a total stranger (who, by the way, may not agree with the first consultant and may wish to do something else - such is medicine!!)

...or will the open referral be a pathway that allows the insurer to chose the consultant for initial consultation from the start? For the reasons stated it my first post, this is also undesirable.

Incidentally, a couple of years ago on holiday, my husband snapped his patellar tendon. And just as we were getting ready to fly home to have this surgically attended to by a surgeon in England, the Icelandic ash cloud thing happened. We were grounded abroad and couldn't get back. The consultant knee surgeon in England whom we'd been in touch with explained that for the best chance of recovery, surgery should be undertaken asap (as I recall, ideally within 7-10 days).

We contacted BUPA and asked what would happen if we could not get back to England within this timescale (no-one knew how long this Icelandic thing would go one for!) - would BUPA be prepared to pay for surgery abroad? Meanwhile, my husband was immobile in a hotel room and had been given some heparin injections by the local doctor to self administer to prevent DVT until we could get back home.

BUPA referred us to their "so-called" medical expert (who turned out to be a registrar rheumatologist - not a surgeon ?!) He advised that the surgery could be performed at any time and that there would be no detriment if it was delayed for a number of months. Needless to say, we informed him what the real expert had said, took his GMC number and threatened to sue BUPA for any adverse incident that could possibly arise as a result of this refusal.....at which point they suddenly became more concerned and changed their tune! I think that this perfectly illustrates the point that insurers are NOT qualified to make clinical decisions!

Last edited by dizzie; 03-05-2012 at 10:09 PM.
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# 3
Wutang
Old 04-05-2012, 8:14 AM
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Your main problem is that you are with Bupa...They are the name people automatically choose when looking into medical insurance. No idea why, I guess people are easily persuaded by marketing these days.

There are other insurers who do not have fee guidelines and there are other insurers who do not place these constraints on their customers.

There are thousands of the older generation who are so brainwashed into thinking that Bupa have always been there for them (despite the occasional payment shortfall) and charge them over 10k a year. Bupa are bad - others are good.

There are so many other options - I really do not understand the tribal fascination a lot of the public have for Bupa medical insurance.

With regards the private patients forum - also avoid. That was a spam from PPF for a terrible site. If the user wants to be treated fairly - they do not access the private patients forum, they take advice by an adviser who will be regulated and therefore you will be protected.
Hi, weve had to remove your signature. If youre not sure why please read the forum rules or email the forum team if youre still unsure - MSE ForumTeam
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# 4
dizzie
Old 04-05-2012, 9:01 AM
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Wutang - you are so right. For some reason, we were fooled into thinking that a "household" name like BUPA would be a safe bet. But I am now beginning to think that BUPA puts more effort into their advertising and marketing than they do into the package of care they offer to their policyholders.

I am aware from the press that BUPA made heavy investment losses during the recession. Similarly, profits are down because many people/companies have given up health insurance due to financial circumstances. It seems that BUPA's answer to boosting profits is now to provide more inferior cover to their remaining members.

Incidentally, with the new schedule of procedures that comes into force on the 21st May, there is now new guidance on spinal injections and the circumstances in which BUPA will pay for these. It would appear from the shambolic nature of this document that the policy writer at BUPA was not an expert in this area. There are NICE guidelines for such conditions but the way that BUPA have interpreted these into a policy shows confusion between the various conditions. This means that patients are definitely going to be short changed despite plenty of clinical evidence (not refuted by NICE) to indicate perfectly acceptable treatments that BUPA will now refuse to pay for.
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# 5
dizzie
Old 09-06-2012, 1:04 PM
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Quote:
Originally Posted by Wutang View Post
Your main problem is that you are with Bupa...They are the name people automatically choose when looking into medical insurance. No idea why, I guess people are easily persuaded by marketing these days.

There are other insurers who do not have fee guidelines and there are other insurers who do not place these constraints on their customers.

There are thousands of the older generation who are so brainwashed into thinking that Bupa have always been there for them (despite the occasional payment shortfall) and charge them over 10k a year. Bupa are bad - others are good.

There are so many other options - I really do not understand the tribal fascination a lot of the public have for Bupa medical insurance.

With regards the private patients forum - also avoid. That was a spam from PPF for a terrible site. If the user wants to be treated fairly - they do not access the private patients forum, they take advice by an adviser who will be regulated and therefore you will be protected.
Hi Wutang,

I understand your point about taking advice from a regulated adviser when choosing an insurance policy, however, I do think that their is a role for the PPF.

My husband went to see his consultant this week - and he is giving his patients a letter written by FIPO about what BUPA are doing. Really, I think BUPA should be writing to their customers and telling them that they are reducing reimbursement levels - after all our insurance contract is between us and them - not the consultant, so I feel that we have the right to be made aware of any changes!

As you know, people are aware that if they change insurer, any pre-existing conditions will be excluded, so many are worried about taking that gamble and moving. But in order to make an informed choice, they need to have complete transparency from their insurer as to any changes that could potentially affect them.

Whilst insurers get away with changes introduced "by the back door", whilst their clients remain blissfully unaware, there is surely a role for a group that encourages patients to stand together and lobby for greater transparency and honesty from the insurance company to whom they pay great chunks of their salaries every month.

...but you do share my opinion about BUPA!

Last edited by dizzie; 09-06-2012 at 1:20 PM.
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# 6
eyedoc
Old 18-08-2012, 2:50 PM
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Default Bupa

The information provided about BUPA is quite true.
They have in the last few months implemented a wide series of new policies throughout the UK, all of which leave members with a worse deal. If the changes were not made clear to members before they signed up/ renewed their membership, you should make a complaint or shop around for a new insurer, or both.

1 Their reimbursement fees for doctors are now much lower than all other insurers, especially for common procedures such as cataract surgery. As a result BUPA members will find they have incomplete cover from almost every eye surgeon in the UK. Members of all other insurance companies will as a general rule find they still have full cover.

2 When a BUPA member is presented with a bill (from the doctor) for their insurance shortfall, BUPA are contacting the member and advising them not to pay, and also phoning the surgeon and pressurising them to waive the fee, with suggestions they will be 'delisted' from future BUPA insured work. This creates confusion and aggravation for all parties.

3 Patients are now being routinely asked by BUPA to travel to different cities for their care, where they have identified a doctor who will work for a lower fee. Do not be misled by the term 'BUPA assured' or 'BUPA recognised' doctor. There is no element of quality in this description. These doctors are chosen purely on cost grounds, and in many cases do not even know they have been chosen. If these doctors then charge more than BUPA want them to charge, BUPA de-recognises them and tries 'recognising' another doctor instead.

4 Many members are now finding that other insurers offer much better cover for lower premiums. This includes the likes of AXA PPP, AVIVA, PruHealth, WPA and CIGNA. There are many other insurers available but I will not write a long list. Members really should do their homework.

5 BUPA has now decided after decades of paying for local anaesthetic as well as surgery, that local anaesthetic will no longer be paid for. If a member now has a procedure they are likely to face a separate bill for this.

6 I have found that when dissatisfied members ask BUPA how they make a written complaint to the chief exec and the ombudsman, and advise that they will be changing insurer, they then are advised their their care will be fully covered after all.

7 In recent months BUPA has seen a huge fall in its membership numbers (approx 140,000 members lost) which is about 5% of their members. They have blamed this on tough market conditions but during this time other insurers have seen their membership rise.

8 BUPA has reduced its surgeon payment from 741 to 289 for cataract surgery. It says this is because modern cataract surgery has become much quicker and easier to do. However, its overall all-inclusive pay-as-you-go-tariff for non-members to have cataract surgery remains unchanged at around 2500. It should be noted that many private hospitals will charge less than this for direct payment.

9 The BUPA open referral system is simply an attempt to remove from you and your GP the choice of which specialist you see.
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# 7
eyedoc
Old 18-08-2012, 3:10 PM
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Quote:
Originally Posted by dizzie View Post
Hi Wutang,

I understand your point about taking advice from a regulated adviser when choosing an insurance policy, however, I do think that their is a role for the PPF.

My husband went to see his consultant this week - and he is giving his patients a letter written by FIPO about what BUPA are doing. Really, I think BUPA should be writing to their customers and telling them that they are reducing reimbursement levels - after all our insurance contract is between us and them - not the consultant, so I feel that we have the right to be made aware of any changes!

As you know, people are aware that if they change insurer, any pre-existing conditions will be excluded, so many are worried about taking that gamble and moving. But in order to make an informed choice, they need to have complete transparency from their insurer as to any changes that could potentially affect them.

Whilst insurers get away with changes introduced "by the back door", whilst their clients remain blissfully unaware, there is surely a role for a group that encourages patients to stand together and lobby for greater transparency and honesty from the insurance company to whom they pay great chunks of their salaries every month.

...but you do share my opinion about BUPA!
Please read my entry below.
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# 8
radoxme
Old 25-01-2013, 11:02 AM
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Default Trust your instincts

Do not use private psychiatry. It is just drug dealing.

The state will pay for any errors of treatment so it is the state that should decide on what pills you are given.

Physical medicine is a different matter. That is real science treating a real disease. For a disease to be present it has to be detectable on an autopsy table.

Medicine has no business expanding into character judgements.
If one is to be made it should be by trial and jury and then the psychiatrist only consulted on the necessary pills to create such a change in personality that the Court has decided on.

Doctors have specific personalities that they perceive as normal. In reality they are not normal. Very few people have their traits. Yet they are tasked with adjusting the population to matching their ideals.

Goodness knows how much the state spends on looking after people who have been misdiagnosed at the hands of private psychiatrists.

Pain has meaning. It makes you take your hand out of the fire. So does psychological pain. Do not give your brain third degree burns by cutting it off.
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# 9
kvunadkat
Old 03-02-2013, 3:32 PM
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Dear MSE Forum

I have had BUPA cover for myself (age 33) andmy parents (ages 56 and 63) for over 15 years now on a personal scheme at thetop level package.

Over the years, as many have said, premiumshave increased but benefits and service have decreased.
Recently, claims for my parents were withheldfor nearly 4 months and treatment for on-going cases were denied due to themtrying to label the care as routine check-ups and then as chronic.
The consultant who had been treating my mothereven argued with BUPA and wrote to them and their head office several times,but his medical opinion was ignored and cover was denied.
Finally after two complaints, the case was seenas a clerical error and they gave authorisation to see the consultant - I amlooking to take legal action as it was concerning an issue that could have beenfatal if it had not been the outcome we were all praying for (cyst vs. a tumourlump in a breast).
I was sent an apology letter and flowers tohelp make a mends!!

Since, we have had other issue with otherclaims (local anaesthetics not being included for a routine procedure, followup consultant fees not being paid when being given alongside treatment etc.)and it is all getting rather frustrating when you are paying premiums close to6000 a year for three people.

My desire is to try and move to anotherprovider and I have been looking at WPA, CIGNA, AVIVA, SIMPLY HEALTH and PRU HEALTH(in that order) to move my policies.
My concerns are pre-existing conditions thathave been treated and covered for since joining BUPA over 15 years ago.
Main issues are low dose cholesterol medicationfor myself and mother (no blood pressure issues and non-smokers.)
Cholesterol is not diet related and overall healthis perfect medication for me is more a preventative (5mg dose) and for motherit is more of an issue as her ratios have been off in the past but control inthe past 5-8 years.

I am speaking to WPA at the moment but it seemsit is so hard to get any real feedback other than full exclusion for currentissues and then they slap an exclusion on other related issues which withcholesterol can be far and wide I assume.

I would appreciate any advice that can begiven.
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# 10
zzzLazyDaisy
Old 03-02-2013, 3:48 PM
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I am in a similar position. I have BUPA cover, but am unable to move to a different insurer as I have a number of conditions which are covered by BUPA, including a serious spinal condition which is likely to need surgery at some point. I am under a specialist spinal surgeon, who I has seen me several times under BUPA as an outpatient, but now I am wondering if it is worth me continuing to pay the BUPA fees if they are going to attempt to have me referred to another surgeon if/when I do need surgery - because that isn't going to happen. I have asked them to confirm that if I should need surgery they will approve continuing care, but just got a fudged 'non-response'. What to do?
I'm a retired employment solicitor. Hopefully some of my comments might be useful, but they are only my opinion and not intended as legal advice.

Letter Before Claim from a parking company? DO NOT IGNORE - THE NEXT STEP IS COURT ACTION. See my thread (page 1 of the parking forum) and FIGHT BACK!
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# 11
rs65
Old 08-05-2013, 7:38 PM
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Quote:
Originally Posted by pwwuk View Post
Openness and transparency is vital
Talking about openness and transparency, I hope your username doesn't have anything to do with the Peter W Walker who is CIO at Freedom - because that would look as if you are trying to promote your own business anonymously.

Also, without being registered as a company rep, it is concerning as Peter W Walker's linkedin profile says he was involved with moneysupermarket and an Internet CIO so you'd think he would know the rules.
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# 12
pwwuk
Old 12-05-2013, 2:44 PM
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How do I register as a company rep ?

Post removed in the meanwhile.
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