BupaCare Scale A, B ,C... lottery?

smilew

Does anybody understand BupaCare scale A, B or C health insurance, I know what it says in the members guide, that the scale refers to the type of accommodation only but does it limit the best private hospitals or just the quality of room within the hospital (extra luxuries etc..).

The reason I ask is, I have rung Bupa and got different answers each time. Once I was told that if you are on scale c (which I am) then you can’t use the best hospitals in central London, and some of them are centres of excellence for cancer treatment etc.

Then I was told I could use the hospital but they wouldn’t guarantee a separate room, to which I asked what if the hospital had all single rooms of the same level and I got the answer “I am sure they would then pay”. My thinking is if the hospital had all single rooms and most do then wouldn’t they be higher than scale c and wouldn’t they then say no to anybody on scale c.

The Bupa website doesn’t make it clear when you look at the hospital list as to which scale it falls under, it only states whether it is a partnership hospital, and the price for renewal depending on choice of scale A B or C is significant.

I appreciate there are some other benefits that differ; compensation paid for staying in a NHS hospital, physiotherapy allowance for example but my main concern is to be able to use the best hospitals should I ever fall ill as an inpatient or their facilities, I am less concerned whether the room has two tvs and more luxiours decor all I care about is that I can use(stay) in the hospital.

So I went through some of the top London hospitals with BUPA and was told that currently they are covered and don’t specify that you need to be on a certain scale, which begs the question shouldn’t BUPA make it clear and what’s the point of paying several hundred pounds more if the scale only refers to the state of the room. Also it makes it difficult to decide on a scale, as if a particular hospital is currently covered under scale c and you renew, what if you fall ill 6 months later and the hospital is now covered under scale B or higher, will they cover you, asked BUPA '..hmmm probably'

Any information would be highly appreciated, BUPA is the only company that does this, most simply ask whether you want a full list or limited list. I raise this because having decided I was covered for any hospital I came across this article

telegraph.co.uk/health/expathealth/7025352/Policy-check-Lynne-Oliver.html

(sorry first post so can't include link add the www to above ) today while comparing policies and now I am worried again, come on BUPA what’s the deal??

Brize

There used to be a meaningful difference between the scales, but they've been collapsed over the years.

As you've found, Bupa can be frustratingly vague on this issue: I was once told that scale A affords you a better view from the window of your hospital room!

smilew wrote: »

all I care about is that I can use(stay) in the hospital.

You've got nothing to worry about. Of the hundreds of Bupa clients that I've looked after over the years, 99% have been on scale C and there hasn't been a single instance where a client has been denied access to a hospital.

smilew

Thank you for the response, just wish they would clear it up so I knew I was fully covered. I agree they probably won’t be an issue, but a part of me still thinks “what if” and unfortunately their vague answers allows them to say no. I would much rather not find out when there is something wrong with me. Even the telegraph article illustrates this, as BUPA repsonse implies it based on ‘therapeutic need’ which is different from best available medical treatment. Why do they have this get out clause, health insurance is one of those things where you really need to read the small print, accept when you do in this case, you are given no definite information, I am thinking of raising it with the regulatory body. This scale applies more to people on old polices, I think the new ones are called select care and simply state whether you can use the full list of hospitals or a limited list, at least you know and it’s not a lottery!!

Brize

smilew wrote:

Thank you for the response, just wish they would clear it up so I knew I was fully covered.

You're welcome - I agree that Bupa could do more to clarify this issue.

smilew wrote:

health insurance is one of those things where you really need to read the small print

As I've said before on these boards, health insurance is a complex product that's best purchased with specialist advice. There's a reason that a group of specialist brokers have grown up around the industry.

artyemz

Hi there,

I have worked for Bupa in the past and now an independent adviser.
The treatment is exactly the same whether you are on scales A, B or C there are only two differences are:
1) NHS Cash Benefit on scale C is £20 per night, Scale B £25 per night and £30 per night on scale
2) Physio - £500 per person per benefit year on Scale C, £650 on scale B and £800 per year.

The only difference in certain hospitals (King Edward VII and Cromwell) when you admitted as day patient or in-patient you might have to share your private room with another person (obviously this would be the same sex as yourself) on that occasion, this use to happen some 20 years ago not so much any more, and the only time this would happen nowadays is if there was a pandemic of some sort, but 90% of private hospitals are kept to third full most of the time. So the chance of this happening is quite slim. I use to advise people on Scale C as all the other treatment is exactly the same. The difference in the premiums on Scale C to Scale B is about 25% more and Scale B to A normally double. If you really wanted a single room for your op you can - arrange to go in on a different day to ensure you get a single room or upgrade at the hospital and pay the hospital direct - this would save you a lot more than paying the extra in the premiums!

styleye

artyemz wrote: »

Hi there,

I have worked for Bupa in the past and now an independent adviser.
The treatment is exactly the same whether you are on scales A, B or C there are only two differences are:
1) NHS Cash Benefit on scale C is £20 per night, Scale B £25 per night and £30 per night on scale
2) Physio - £500 per person per benefit year on Scale C, £650 on scale B and £800 per year.

The only difference in certain hospitals (King Edward VII and Cromwell) when you admitted as day patient or in-patient you might have to share your private room with another person (obviously this would be the same sex as yourself) on that occasion, this use to happen some 20 years ago not so much any more, and the only time this would happen nowadays is if there was a pandemic of some sort, but 90% of private hospitals are kept to third full most of the time. So the chance of this happening is quite slim. I use to advise people on Scale C as all the other treatment is exactly the same. The difference in the premiums on Scale C to Scale B is about 25% more and Scale B to A normally double. If you really wanted a single room for your op you can - arrange to go in on a different day to ensure you get a single room or upgrade at the hospital and pay the hospital direct - this would save you a lot more than paying the extra in the premiums!

I have repeatedly been told by BUPA on renewal that certain hospitals in London only accept scale A members.

Although BUPA continue to insist that that the scale does not affect the "quality of care you receive"this makes NO SENSE. If you want to go to a certain hospital and for whatever reason they choose to charge the top price for their rooms then it isn't about sharing, my understanding is that you don't qualify if you are on scale c. This has been confirmed by BUPA countless times.

It really is a disgrace as even if you were to ring BUPA today you would get three different answers from their advisers. They have no clue. Also they say the list (scale of room) can change any time how is it even legal that they can do this.

I don't know whether it is worth changing to another scheme that simply includes the London option either the hospital is in or out simple, and not this dumb scale lottery which you only find out on the day you need to use it.

See the latest BUPA hospital list May 2012

bupa.co.uk/intermediaries/int-literature/hospital-lists

no mention of what hospital is under what scale

Then to further complicate things in the list above they refer to hospitals as Participating and Partnership (in grey) my policy states "participating" hospitals so does that include the ones in grey? Asked Bupa again 2 different answers yes and no!!

Now here is a list from 2009 notice the scales:

bupa.co.uk/intermediary/pdfs/participating-feb2009.pdf

why have they not clarified them on latest list in 2012.

The whole thing is so confusing and simply for the sake of being confusing. And only for BUPACare patients, which I believe is one of their biggest and oldest schemes.

dizzie

Although this is an old thread, I would like to concur that I have also found that you can phone BUPA twice on the same day, ask the same question - and be told two entirely different things.

The OP talked about access to some of the top hospitals in London where perhaps some of the best specialists in a particular area practice. Certainly, the top London hospitals don't have exclusivity on the best doctors - there are plenty to be found in other hospitals. However, regardless of whether you are on BUPACare A, B or C - your access to some of the best specialists may start to become very limited. Here's why...

New specialists can now no longer register as a provider with BUPA unless they agree to keep within BUPA's fee schedule. Specialists registered a while ago don't have to keep to this fee schedule, but many entered into an agreement with BUPA to do so (they are referred to as "fee-assured specialists"). Now, when doctors signed this agreement, what they didn't realise was that BUPA was not going to increase the rates of pay. In fact until recently, this has been held at 1992/3 rates. This year, however, they have revised these rates - now slashing many of them massively (45-70% in some cases), whilst only increasing fees for a few procedures (mostly the rarer ones that are hardly ever performed!).

Now consultants have a dilemna. Anyone who entered into a fee agreement many years ago with BUPA has two choices:

1. To accept a huge pay cut - after relatively static pay from BUPA over the last 20 years, or
2. To refuse to accept the pay cuts - in which case, the consultant will no longer be BUPA recognised.

Doctors are furious about BUPA's fee cuts. They are now paying significantly less than other insurers for many procedures.

Now the top specialists - those who are very much in demand, can actually afford to say "no" to BUPA - in which case if they do - BUPA won't pay for us to see them. We won't even have the option of choosing them and agreeing to pay a "top-up" ourselves to BUPA's reimbursement because BUPA won't allow it.

....and if you've got BUPA insurance through work, it's even worse. Their "open referral scheme" means that BUPA (not the referring doctor) will pretty much decide who you will see, and they'll give you maybe two or three names to chose from based upon who is the cheapest on their books!

It's all a nightmare really!...

styleye

dizzie wrote: »

....and if you've got BUPA insurance through work, it's even worse. Their "open referral scheme" means that BUPA (not the referring doctor) will pretty much decide who you will see, and they'll give you maybe two or three names to chose from based upon who is the cheapest on their books!

It's all a nightmare really!...

Interesting you mention the open referral scheme, i couldn't agree more the idea of not being able to pick the best consultant for a procedure is without a doubt the most stupid thing BUPA has done to date, other then speed what's the difference between open referral and the NHS!! Nothing

This is how they are telling their sales people to sell it, if you are on BUPA Select you have this to look forward to when you fall ill:

bupa.co.uk/jahia/webdav/site/bupacouk/shared/Documents/PDFs/Intermediaries/pdf/38736-open-referral-Q%26A.pdf

it is a joke you can't choose a consultant a operator and a computer league table with the cheapest consultant will be chosen for you. I think even if the consultant is registered with bupa according to the document above they will pick a consultant close to your house the option of London or another major city where the best tend to practice may never be an option, unless you happen to live in the city itself. So if you have a rubbish private hospital near you that's where you will go and they will pick who you see.

The worst thing about this is the vast majority of members simply don't understand how important it is to have access to some of the best hospitals and doctors, until recently BUPA used to be the gold standard, you would see these mickey mouse practices with other companies but never BUPA, out of interest does anyone know other companies that are better, i suspect they are all at it equally, but open referral you couldn't make it up but BUPA just did.

dizzie

Hi Styleye,

Nope, I think that BUPA are "paving the way" on this one. I'm not so sure that they ever were "the gold standard", but of course they are a big name and they advertise everywhere so they are well known. Clearly, this is where they spend their money. On the subject of other insurers, I understand that Simply Health are also introducing an "open referral scheme" but importantly - it will be voluntary (not compulsory) - i.e. you can accept their suggestion or opt to see someone of your own (or your GP's) choice - presumably you'd just have to pay the difference if the one you wanted to see charged more. That idea, I can live with...but compulsory open referral where BUPA get to pick? No way am I okay with this.

Actually, having done a bit of research, BUPA now appear to pay out less than everyone else and and are also imposing more restrictions on what you can and can't have - so that must make them possibly the worst provider in my book.:mad:

Wutang_2

dizzie wrote: »

Actually, having done a bit of research, BUPA now appear to pay out less than everyone else and and are also imposing more restrictions on what you can and can't have - so that must make them possibly the worst provider in my book.:mad:

Wow. They may well be the strictest when it comes to funding claims but the "worst"?? Ever heard of Health On Line (and more importantly their sales staff?), ever read Simply Health's cancer cover, ever spoken to Aviva's claims department etc.

Bupa have fantastic cancer cover and although they might be about 6 million years behind the times, they are by NO means the worst.

Wutang_2

dizzie wrote: »

Now consultants have a dilemna. Anyone who entered into a fee agreement many years ago with BUPA has two choices:

1. To accept a huge pay cut - after relatively static pay from BUPA over the last 20 years, or
2. To refuse to accept the pay cuts - in which case, the consultant will no longer be BUPA recognised.

Doctors are furious about BUPA's fee cuts. They are now paying significantly less than other insurers for many procedures.

Now the top specialists - those who are very much in demand, can actually afford to say "no" to BUPA - in which case if they do - BUPA won't pay for us to see them. We won't even have the option of choosing them and agreeing to pay a "top-up" ourselves to BUPA's reimbursement because BUPA won't allow it.

....and if you've got BUPA insurance through work, it's even worse. Their "open referral scheme" means that BUPA (not the referring doctor) will pretty much decide who you will see, and they'll give you maybe two or three names to chose from based upon who is the cheapest on their books!

It's all a nightmare really!...

Its not really a nightmare....Many consultants now state they charge "bupa+20%"...thats probably £30 to see a specialist.

Many policies nowadays cover all outpatient diagnostics but no outpatient consultant fees, therefore you pay the specialist, the insurer does the rest.

Either way - its still an improvement on the NHS waiting lists etc.