NHS Private referral bill dispute who is in the wrong?

MyUsername

Hi guys someone I know has a dispute over payment with a private hospital over an NHS referred operation and I was wondering if you could help.

Someone I know needed an operation and their NHS trust referred them to a private hospital for treatment which was paid for by the NHS.

At the same time however they asked if the same operation could be done on something else they were having problems with and the surgeon said that it could be done but their GP would need to refer them to have the second operation. They spoke to the GP who referred them to the hospital for the 2nd operation. The 2nd operation was done shortly after this.

Shortly after however they then get a bill in the post from the private hospital for the 2nd operation. Puzzled they then phone up the Hospital and mention that they were under the impression that it was an NHS funded operation. The private hospital then mentions that it wasn't an NHS funded operation.

Both the GP and private hospital have now admitted it wasn't an NHS funded operation and admitted not making it clear at the time of the operation on the grounds that the person having the operation should have asked who was paying for the operation and because the question wasn't asked they weren't required to make them aware of this that the time as the person having the operation didn't ask.

My question is though who is in the wrong in this situation and is the patient liable for the cost of the operation?

peachyprice

I would say the patient is in the wrong. They asked their GP to refer them to the private hospital for the operation they wanted, which the GP did, which is normal procedure.

Just because the original operation was available at the private hospital doesn't follow that the second one automatically was. So unless the patient specified that they wanted to go on the NHS waiting list for that op at that hospital they will be liable for the bill for the operation they asked for the private referral for.

sheramber

A GP would normally refer a patient to an NHS consultant , who would decide the appropriate treatment. If the NHS hospital deemed it necessary then it would refer the patient to the private hospital, having agreed to cover the cost.

A GP would not refer a patient direct to a private hospital to be treated at the cost of the NHS.

Your acquaintance asked for a referral direct to a private hospital , therefore he is private patient.

peachyprice

sheramber wrote: »

A GP would not refer a patient direct to a private hospital to be treated at the cost of the NHS.

Well, yes, they would in some LHA's, it happens here, my husband had a shoulder operation last year at a private hospital as an NHS patient, so I can easily see why the first operation could have been as a private hospital. But that's not to say that all operations are available there.

helcat26

I am afraid your friend is liable.
In the case of the 1st op they had an NHS referral from the GP and then the NHS subcontracted it to the private hospital. In the case of the second operation the NHS were not involved in deciding where it would take place so the private hospitals contract was with the patient.
I have had ops in private hospitals paid for by health insurance, privately and as a result of the treatment being through the NHS. In the private hospitals there was always a form to be filled in before treatment about how the patient's treatment was going to be paid for asking for credit card details, health insurance details or if it was NHS being marked already as NHS.
Your friend must have signed such a form.

Toothsmith

My opinion is that this is a problem with consent - and it is the hospital/surgeon who is to blame.

If this were a dentist - and a patient had 'accidentally' had some treatment privately, then the dentist would really be in the soup if there was not proper signed documentation to say that the patient had been told, and understood, which elements of treatment were NHS and which were private.

As part of the consent process for this second operation, the surgeon should have made it clear that it was private, they should have checked you had insurance to cover it, or they should have made you aware exactly how much it would cost if you had no insurance.

They should be able to produce some signed documentation that says you were made aware that it was private, and that you understood the cost. If they can't do that then they have not obtained 'informed consent' to the operation, and they are in trouble.

This is my opinion though - not fact. I'm pretty sure a solicitor would make a lot out of no proper informed consent though.

MyUsername

From what I gather the GP has admitted that they didn't make them aware that my acquaintance would have to pay for it as it would be a private operation and they should have done. The Consultant at the Hospital has also admitted that they didn't make them aware that it would be a private appointment but say that they weren't at fault because of it. From what I gather though the Hospital has said that the cost wasn't made aware of the fee at the start but they say that is standard practice.

In any case though my acquaintance was negligent in this situation and should have asked more questions before the procedure took place.

Toothsmith

It is up to the hospital to tell the patient - not the patient to ask.

I would tell them to get proper advice from somewhere like Citizen's Advice.

How much are we talking? Hundreds or Thousands? If a GA was involved, this could be a very big bill indeed. I would think some sort of reduction would be in order, at the very least.

[Deleted User]

Toothsmith wrote: »

I would tell them to get proper advice from somewhere like Citizen's Advice.

In my experience they just refer you to the Health Ombudsman, but they only cover private hospitals if the treatment is funded by the NHS. Catch 22: you might need a decision about who's liable before the Ombudsman will consider the case.

Toothsmith

If the bill is large - then see if any local injury/medical lawyers do a free 1/2 hour consultation. This wouldn't be a no win no fee case, obviously - as it's not compensation, just a bill dispute. But a solicitor's letter to the hospital might get a result for less money than they allegedly owe!

That is if the solicitor agrees that this is a lack of consent issue.

FBaby

A GP would not refer a patient direct to a private hospital to be treated at the cost of the NHS.

That is not correct. Many private hospitals offer NHS treatments that GPs can refer directly to.

Both the GP and private hospital have now admitted it wasn't an NHS funded operation and admitted not making it clear at the time of the operation on the grounds that the person having the operation should have asked who was paying for the operation and because the question wasn't asked they weren't required to make them aware of this that the time as the person having the operation didn't ask.

Sorry this doesn't make sense. You say both the GP and hospital admitted they had not made it clear to the patient that the intervention would need to be self-funded as not available on the NHS? If so, then I expect they have accepted the liability and your friend doesn't have to pay?

Or are you saying that they have confirmed it was a non NHS funded intervention but said that it was the patient's responsibility to ask if it would be NHS or self-funded and as they didn't ask, it is their fault?

I expect the truth is somewhere in between. The GP should have informed, at some point prior to referral (could have been months before at a previous visit to the GP) that this was not available on the NHS. It should also have been made clear by the hospital that he was being treated privately. It would be expected that the patient would have an appointment to see the consultant first before surgery, and payment is often requested there and then, or at least for payment options to be discussed.

If indeed the GP never informed the patient that the referral would be private, and the hospital never discussed costs, then I would think he might have a case. If however he was made aware that the intervention wasn't available on the NHS (and it doesn't matter which hospital he is referred to) and/or he paid for the consultation, but pretends that he didn't know he would also need to pay for the surgery, then I think he has no chance whatsoever to get a claim from the GP/hospital.