Bupa won't pay surgeon's full fees
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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.
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.0 -
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.
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.0 -
NeverEnough wrote: »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.
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.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 ForumTeam0 -
NeverEnough wrote: »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.
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. :mad: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 ForumTeam0 -
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.
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.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 ForumTeam0 -
NeverEnough wrote: »you seem to be running some sort of vendetta against BUPA, .
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 ForumTeam0 -
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.
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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!
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SteveRogers wrote: »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.
I wish all the Bupa suckers would read this:embarasse:embarasse:embarasse:embarasse:embarasse:embarasse:embarasse:embarasse:embarasseHi, 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 ForumTeam0 -
A small update - my OH went to see the consultant and offered to pay the additional fees if necessary (we want to stay on his good side in case more surgery is needed in the future, which is a real possibility). Since then, we've been copied in on a pretty p*ssed off letter from the consultant to BUPA asking them what on earth they are playing at. We'll have to see what happens!0
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