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  • FIRST POST
    • tyllwyd
    • By tyllwyd 18th Nov 12, 12:45 PM
    • 5,383Posts
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    tyllwyd
    Bupa won't pay surgeon's full fees
    • #1
    • 18th Nov 12, 12:45 PM
    Bupa won't pay surgeon's full fees 18th Nov 12 at 12:45 PM
    My OH recently had surgery under the BUPA cover provided through his employer. He was told that there would be an excess to pay, and that there would be extra to pay to the anethetist, but that the full cost of the actual surgery would be covered by the scheme.

    We've now had a letter through from BUPA telling us that the surgeon has invoiced for (approx) £500 but they have only paid £300 and that we aren't liable to pay the difference of £200. My OH is due to see his surgeon for the post-op follow up, and he isn't quite sure where he stands. We would be quite willing to accept that the operation was probably more difficult than originally anticipated (due to complications from previous surgery) and pay the £200, but we aren't sure whether to expect the surgeon to raise it with us or whether we should just accept what BUPA has said and leave them to argue it out between themselves. Has anyone else been in this position?
Page 1
    • NeverEnough
    • By NeverEnough 18th Nov 12, 12:58 PM
    • 900 Posts
    • 735 Thanks
    NeverEnough
    • #2
    • 18th Nov 12, 12:58 PM
    • #2
    • 18th Nov 12, 12:58 PM
    It depends on your contract with BUPA - if there is an excess mentioned, you would need to pay that, (is that not part of the £200??) and also anaesthetist costs if that again is mentioned as not being covered. Your liability under the contract should end there, unless there is another clause stating you will be liable for additional costs invoiced by providers not included in the excess or anesthetist fees - BUPA has said this is not the case, so just pay what you are contractually obliged to pay.

    Surgeons / other doctors working in BUPA hospitals sign up to charge fees within a certain scale - if this surgeon is charging outside of what BUPA allows, then the charge will not be payable. Either way, seems BUPA is dealing with it, just liaise with their accounts dept. and find out what you are contractually required to pay. Hope OH is well soon.
  • Wutang
    • #3
    • 18th Nov 12, 1:00 PM
    • #3
    • 18th Nov 12, 1:00 PM
    My OH recently had surgery under the BUPA cover provided through his employer. He was told that there would be an excess to pay, and that there would be extra to pay to the anethetist, but that the full cost of the actual surgery would be covered by the scheme.

    We've now had a letter through from BUPA telling us that the surgeon has invoiced for (approx) £500 but they have only paid £300 and that we aren't liable to pay the difference of £200. My OH is due to see his surgeon for the post-op follow up, and he isn't quite sure where he stands. We would be quite willing to accept that the operation was probably more difficult than originally anticipated (due to complications from previous surgery) and pay the £200, but we aren't sure whether to expect the surgeon to raise it with us or whether we should just accept what BUPA has said and leave them to argue it out between themselves. Has anyone else been in this position?
    Originally posted by tyllwyd
    This is the ongoing problem with Bupa (with many Bupa customers who have to claim), they are a truly awful company.

    There is little you can do apart from ask surgeon to reduce cost..

    Even if you have Bupa as a work benefit, (as you have spotted) it can still cost you. Leave them and get a proper medical insurance plan once this procedure is finished.

    There are so many Bupa customers that are brainwashed (by the name) and also, frighteningly, lots of Bupa customers refusing to accept that they are an appalling outfit.
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  • Wutang
    • #4
    • 18th Nov 12, 1:01 PM
    • #4
    • 18th Nov 12, 1:01 PM
    Your liability under the contract should end there
    Originally posted by NeverEnough
    Sorry but this sounds like guesswork
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    • prowla
    • By prowla 18th Nov 12, 1:11 PM
    • 9,826 Posts
    • 7,928 Thanks
    prowla
    • #5
    • 18th Nov 12, 1:11 PM
    • #5
    • 18th Nov 12, 1:11 PM
    I once got chased by debt collectors for a portion of a bill for dental work that BUPA said I owed them; me and the specialist both saying it was all-inclusive and that I had paid in full didn't seem to be good enough for them.

    It took a long time for it to be resolved.
    • magpiecottage
    • By magpiecottage 18th Nov 12, 2:14 PM
    • 9,086 Posts
    • 5,584 Thanks
    magpiecottage
    • #6
    • 18th Nov 12, 2:14 PM
    • #6
    • 18th Nov 12, 2:14 PM
    BUPA is an insurer and is covered by the Financial Ombudsman Service.

    If you have a dispute with them make a complaint to BUPA. If that does not produce a satisfactory outcome, complain the FOS.
    • NeverEnough
    • By NeverEnough 18th Nov 12, 7:15 PM
    • 900 Posts
    • 735 Thanks
    NeverEnough
    • #7
    • 18th Nov 12, 7:15 PM
    • #7
    • 18th Nov 12, 7:15 PM
    Sorry but this sounds like guesswork
    Originally posted by Wutang
    It's not actually - if you have an agreement for a service, it depends on the terms of your contract as to what you need to pay. OP has already stated there is an "excess" - so the £200 must include at least some of the said excess. Plus surgeons working from BUPA hospitals have an upper fee limit they can charge.

    Are you always offensive and rude ? Nice to hide behind your keyboard sniggering in your anonymity?? Pathetic.
  • On_My_Lonesome
    • #8
    • 18th Nov 12, 7:24 PM
    • #8
    • 18th Nov 12, 7:24 PM
    When you call BUPA to pre-authorise they will tell you that if the surgeon/anaesthetist etc charge over BUPA agreed fees then you will be liable for this extra, did they not tell you that when you called to pre-authorise? If not worth getting them to listen to the call to confirm this and that should help your cause.

    I called to pre-authorise last week and it was very clearly explained, I already knew my surgoen always charges within defined limits though.
  • Wutang
    • #9
    • 18th Nov 12, 7:41 PM
    • #9
    • 18th Nov 12, 7:41 PM
    When you call BUPA to pre-authorise they will tell you that if the surgeon/anaesthetist etc charge over BUPA agreed fees then you will be liable for this extra, did they not tell you that when you called to pre-authorise? If not worth getting them to listen to the call to confirm this and that should help your cause.

    I called to pre-authorise last week and it was very clearly explained, I already knew my surgoen always charges within defined limits though.
    Originally posted by On_My_Lonesome
    Lonesome: valid point, only very few consultants work with Bupa currently which has caused a rift amongst consultants themselves. If Bupa got with the times then this shortfall wouldn't happen. Trouble is, they're refusing to.
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    • tyllwyd
    • By tyllwyd 18th Nov 12, 10:01 PM
    • 5,383 Posts
    • 4,369 Thanks
    tyllwyd
    We are due to pay an excess of £50 to Bupa - this is a separate issue and that's not a problem. It was made quite clear that anethesist would charge more than BUPA would pay and we would be liable for the difference - again, we understood that and it is not a problem. The problem is that we did get the surgery pre-authorised and we were told it was fully covered. We dont understand why BUPA is not paying the full amount of the surgeon's fee, and why they are telling us that we are not liable for the £200 difference - and if we can expect the surgeon to chase us directly, considering that this was not agreed beforehand.
    Last edited by tyllwyd; 18-11-2012 at 10:17 PM.
    • NeverEnough
    • By NeverEnough 18th Nov 12, 10:05 PM
    • 900 Posts
    • 735 Thanks
    NeverEnough
    Where was that 'offensive and rude'? If this insults you, life is going to be a struggle. Ironically I am now sniggering as you sound like you're making up your responses and you've use the word 'pathetic' without being sarcastic. Now go to bed. Pathetic
    Originally posted by Wutang
    Scuttle off into your hole and don't issue orders which I would never listen to, anyway. Obviously you didn't graduate from any charm school, that's for sure, you nasty little person.
    • NeverEnough
    • By NeverEnough 18th Nov 12, 10:09 PM
    • 900 Posts
    • 735 Thanks
    NeverEnough
    Lonesome: valid point, only very few consultants work with Bupa currently which has caused a rift amongst consultants themselves. If Bupa got with the times then this shortfall wouldn't happen. Trouble is, they're refusing to.
    Originally posted by Wutang
    Nonsense. Many consultants have private practices utilising BUPA facilities. Do try to get the facts right - difficult when you seem to be running some sort of vendetta against BUPA, of course, but nonetheless grossly inaccurate to state that "very few" consultants work with BUPA.
    • Lorian
    • By Lorian 18th Nov 12, 10:26 PM
    • 4,358 Posts
    • 2,478 Thanks
    Lorian
    We are due to pay an excess of £50 to Bupa - this is a separate issue and that's not a problem. It was made quite clear that anethesist would charge more than BUPA would pay and we would be liable for the difference - again, we understood that and it is not a problem. The problem is that we did get the surgery pre-authorised and we were told it was fully covered. We dont understand why BUPA is not paying the full amount of the surgeon's fee, and why they are telling us that we are not liable for the £200 difference - and if we can expect the surgeon to chase us directly, considering that this was not agreed beforehand.
    Originally posted by tyllwyd
    It doesn't make sense. I'd have expected the anaesthetist to submit his own bill to BUPA. Ring BUPA and ask what's going on. If you get no joy ring the consultant's office.
  • Wutang
    Nonsense. Many consultants have private practices utilising BUPA facilities. Do try to get the facts right - difficult when you seem to be running some sort of vendetta against BUPA, of course, but nonetheless grossly inaccurate to state that "very few" consultants work with BUPA.
    Originally posted by NeverEnough
    Similar to Bupa you are out of touch. Ring around and ask any private hospital if you were referred to them regarding your (insert condition) whether all the costs would be covered by your current insurer, Bupa.

    What are Bupa facilities?

    It's not a vendetta, it is MSE and (look Bupa up on here) they are ripping customers off.
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  • Wutang
    Scuttle off into your hole and don't issue orders which I would never listen to, anyway. Obviously you didn't graduate from any charm school, that's for sure, you nasty little person.
    Originally posted by NeverEnough
    Not aware of charm school but unlike you, speak fact. You are the hypocrite being abusive and making up stories, you should be removed from this forum but no doubt, you'll post again with more misguided opinions.
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  • Wutang
    It doesn't make sense. I'd have expected the anaesthetist to submit his own bill to BUPA. Ring BUPA and ask what's going on. If you get no joy ring the consultant's office.
    Originally posted by Lorian
    This does make sense. Bupa's fee schedules are still based on 1993 rates although, I have been made aware that the surgeons have been contacting the patient before the treatment explaining that there will be a shortfall due to the restrictive costs Bupa will pay. You should have been informed. Trouble is, now, contacting Bupa or the consultant is going to make very little difference as in general, the current theme is that neither are budging to accommodate the other.

    Ignore the guy making up the stories too - pure ignorance not helping your circumstances.
    Last edited by Wutang; 19-11-2012 at 7:05 AM. Reason: Pathetic
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  • Wutang
    you seem to be running some sort of vendetta against BUPA, .
    Originally posted by NeverEnough
    http://www.thesundaytimes.co.uk/sto/business/money/Consumer/article1164657.ece

    Hi, we’ve had to remove your signature. If you’re not sure why please read the forum rules or email the forum team if you’re still unsure - MSE ForumTeam
  • SteveRogers
    BUPA anti-competitve practices

    Competition Commission submission –anti-competitve practices by BUPA

    BUPA Feeassured

    BUPA claimsto have introduced ‘fee assured’ as a way of preventing customers from having ashortfall on fees. However BUPA is using the mechanism to force consultants tocharge lower fees. There is no transparency in the market regarding consultantsfees. Consultants generally do not publish details of their fees on theirwebsites and secretaries are coy about revealing them even when directlyquestioned. Bupa does not publish a list detailing individual consultants feeseither. As such consultants have no reference point when setting or negotiatingfees with BUPA, only BUPA knows what the ‘going rate’ is.

    If BUPAthinks a consultants fees are too high, they often threaten to ‘de-list’ aconsultant, but it is rare that they actually go this far, the threat isusually enough. Many consultant acquiesce as a result of the bullying and agreeto lower their fees. Since BUPA is a near monopoly PMI provider, consultantsfear they would lose too much business if they lost BUPA recognition.

    A morecommon tactic is that BUPA actively prevents its customers from bookingappointments with non-fee assured consultants. When a customer phones BUPA toobtain a pre-authorisation for a non-fee assured consultant, the BUPA adviserswill make extensive attempts to persuade the BUPA member to see someone else(who is fee assured). I have heard from many patients who say they couldn’t getoff the phone until they agreed for their referral to be changed.

    Often thenon-fee assured consultant has been charging the same prices for over a decade.The only movement has been with BUPA’s willingness to pay!

    Nearly all newconsultants are being forced into fee assured status by BUPA, meaning BUPA isable to dictate on price. If a new consultant does not agree to the price setby BUPA, they are not given recognition – a Catch-22. This means BUPA isforcing prices down through attrition, as older consultants eventually retire.

    One of the outcomesof BUPA fee assured is that BUPA members are increasingly unable to access the ‘best’or more experienced consultants whose prices BUPA deems ‘too high’. Many ofthese consultants will not agree to become fee assured, because the prices areset too low. As a result BUPA members are increasingly forced to see juniorconsultants.

    One finalpoint. BUPA accepts different fees from different specialities. Why? Allconsultants are equally qualified. In the NHS, all consultants are paid exactlythe same salary. The only difference being applied for years in service andexcellence awards.

    BUPAFinder

    BUPA hasrecently introduced a website called ‘finder’. This is public facing, but isalso used by BUPA member service advisers to make recommendations to BUPAmembers about which consultants to see. The algorhythm for this site ranksconsultants according to proximity, key words and most importantly – fee assuredstatus. Consultants who are not fee assured are ranked lower, and thus unlikelyto be chosen.

    Open referrals

    One of thereason patients ‘go private’ is so that they can choose which consultant theywant to see. BUPA is increasing forcing members to accept ‘open referrals’whereby BUPA chooses the consultant on the members behalf. At this juncture,BUPA will only refer to fee assured consultants, or consultants within its owncentres.

    BUPA wasforced to sell off its hospitals, but it still actively tries to redirectmembers to the Cromwell Hospital and BUPA Wellness centres.

    Qualityof Consultants

    BUPA’s ownstandard for recognition is that a consultant be listed on the GMC’s specialistregister, in a recognised speciality, and that they hold, or have held asubstantive NHS Consultant post.

    However,BUPA is not sticking to its own rules. When it sees fit, BUPA will employunqualified ‘consultants’ within its own wellness centres. These doctors areoften GP’s with minimal qualifications.
  • andyroo64
    Bupa
    I am sorry to hear that about Bupa! I sell Private Medical Insurance for WPA.

    Our approach is different – and this is well stated on our web site's home page:
    • We believe that you, advised by your doctor, should have the freedom to choose your specialist based on your needs and circumstances.
    • We believe that this should be a clinical not a commercial decision.
    • We believe that Open Referral - where some insurers ´choose´ the consultant - is a contradiction in terms: private medical insurance is an elective purchase, giving policyholders the freedom to choose.
    • A patient´s choice is normally based on their GP´s recommendation or it may be based on their own research; in many cases it is because the consultant is someone whom they have seen previously.
    • With Open Referral patients may therefore lose their primary choice of consultant and possibly of hospital. They may still receive appropriate treatment for their condition but not all consultants have the same specialist interests.

    In addition as you know our Guidance to consultants is clear. We set Customary and Reasonable Fees for each procedure which are regularly reviewed by WPA´s Medical Advisory and Clinical Governance Committee. We advise consultants that 'In the event that your pre-advised fees are greater than our level of reimbursement, then it is the policyholder´s duty to settle the difference.'
    • In the event that a patient is not reasonably advised of fees (in writing) in advance, and there is a shortfall that they have not agreed to, we reserve our rights to support the patient in resisting such demands.

    Additional points….

    1.Insurers help their customers fund their healthcare. We do not believe that we should direct treatment plans. Medical decisions should be made by medical people rather than be driven by commercial imperative.
    2.Like WPA, most insurers have fee schedules up to which they will refund customers when they receive private treatment. WPA operates a ‘freedom to choose’ philosophy where customers can be treated by whom they want, when they want and where they want.
    3.Consultants should be able to charge what they want providing they inform customers at the earliest opportunity what their costs are.
    4.WPA will pay up to what we believe is customary and reasonable – the fee schedule. To the extent that nearly 98% of claims are paid in full.
    5.Some insurers direct their customers to certain consultants. This undermines one of the predominant reasons why customers buy medical insurance – to extend the choices that they would have otherwise and to attain a greater control of how they can get the most appropriate treatment.
    6.As an industry we could do better in articulating the value of what medical insurance does. It can be expensive; premiums reflect claims and we are in effect spending our customers’ money as effectively as possible. Watchdog is correct in observing that premiums are going up and we have innovations like Shared Responsibility to help cut premiums without cutting the cover.
    7.WPA is moving against the market trend with a growth in customers in 2012. We are financially strong. This is a reflection of having some great products, effective technology, and a culture that is driven by putting customers at the centre of all that we do.

    Andy
    PS i am happy to give anyone a quote!

  • Wutang
    Competition Commission submission –anti-competitve practices by BUPA

    BUPA Feeassured

    BUPA claimsto have introduced ‘fee assured’ as a way of preventing customers from having ashortfall on fees. However BUPA is using the mechanism to force consultants tocharge lower fees. There is no transparency in the market regarding consultantsfees. Consultants generally do not publish details of their fees on theirwebsites and secretaries are coy about revealing them even when directlyquestioned. Bupa does not publish a list detailing individual consultants feeseither. As such consultants have no reference point when setting or negotiatingfees with BUPA, only BUPA knows what the ‘going rate’ is.

    If BUPAthinks a consultants fees are too high, they often threaten to ‘de-list’ aconsultant, but it is rare that they actually go this far, the threat isusually enough. Many consultant acquiesce as a result of the bullying and agreeto lower their fees. Since BUPA is a near monopoly PMI provider, consultantsfear they would lose too much business if they lost BUPA recognition.

    A morecommon tactic is that BUPA actively prevents its customers from bookingappointments with non-fee assured consultants. When a customer phones BUPA toobtain a pre-authorisation for a non-fee assured consultant, the BUPA adviserswill make extensive attempts to persuade the BUPA member to see someone else(who is fee assured). I have heard from many patients who say they couldn’t getoff the phone until they agreed for their referral to be changed.

    Often thenon-fee assured consultant has been charging the same prices for over a decade.The only movement has been with BUPA’s willingness to pay!

    Nearly all newconsultants are being forced into fee assured status by BUPA, meaning BUPA isable to dictate on price. If a new consultant does not agree to the price setby BUPA, they are not given recognition – a Catch-22. This means BUPA isforcing prices down through attrition, as older consultants eventually retire.

    One of the outcomesof BUPA fee assured is that BUPA members are increasingly unable to access the ‘best’or more experienced consultants whose prices BUPA deems ‘too high’. Many ofthese consultants will not agree to become fee assured, because the prices areset too low. As a result BUPA members are increasingly forced to see juniorconsultants.

    One finalpoint. BUPA accepts different fees from different specialities. Why? Allconsultants are equally qualified. In the NHS, all consultants are paid exactlythe same salary. The only difference being applied for years in service andexcellence awards.

    BUPAFinder

    BUPA hasrecently introduced a website called ‘finder’. This is public facing, but isalso used by BUPA member service advisers to make recommendations to BUPAmembers about which consultants to see. The algorhythm for this site ranksconsultants according to proximity, key words and most importantly – fee assuredstatus. Consultants who are not fee assured are ranked lower, and thus unlikelyto be chosen.

    Open referrals

    One of thereason patients ‘go private’ is so that they can choose which consultant theywant to see. BUPA is increasing forcing members to accept ‘open referrals’whereby BUPA chooses the consultant on the members behalf. At this juncture,BUPA will only refer to fee assured consultants, or consultants within its owncentres.

    BUPA wasforced to sell off its hospitals, but it still actively tries to redirectmembers to the Cromwell Hospital and BUPA Wellness centres.

    Qualityof Consultants

    BUPA’s ownstandard for recognition is that a consultant be listed on the GMC’s specialistregister, in a recognised speciality, and that they hold, or have held asubstantive NHS Consultant post.

    However,BUPA is not sticking to its own rules. When it sees fit, BUPA will employunqualified ‘consultants’ within its own wellness centres. These doctors areoften GP’s with minimal qualifications.
    Originally posted by SteveRogers
    I wish all the Bupa suckers would read this:embar asse
    Hi, we’ve had to remove your signature. If you’re not sure why please read the forum rules or email the forum team if you’re still unsure - MSE ForumTeam
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