How private health cover could force you into the hands of cut-price doctors

For two decades entrepreneur Jacqueline Wigg and her husband John have scrimped to afford the £3,500 a year it cost to get private health cover from Britain’s biggest health insurer, Bupa. The Wiggs thought the sacrifice would be worth the peace of mind private health coverage gave them. Indeed, when earlier this year Mrs Wigg, 68, noticed her eyesight had become blurred and she was diagnosed with cataracts, she was relieved she had the cover. But that relief was shortlived.

The Mail's doctor, Martin Scurr, fears cheaper doctors might be tempted to jam in more patients to boost their earnings

For Bupa told her she would have to pay £1,200 if she wanted to be treated by the well-respected specialist her consultant recommended.

Alternatively, she could have the procedure done at no extra cost — in a branch of opticians Optical Express based in London’s busy Westfield Shopping Centre, 100 miles away from her home in Warminster, Wiltshire. The ultimatum came because Bupa had slashed the amount it would pay for cataract surgery from £761 for each eye to £289 — a cut of more than 60 per cent.

Mrs Wigg had expected to pay £300 to cover the difference between what the insurer would pay for and her doctor’s bill.  But now she would have to find four times this amount or have the operation done at Optical Express (as part of a deal the High Street chain had thrashed out with Bupa earlier this year).

Understandably, she was furious. ‘The reason for paying for medical insurance with Bupa was so we would be given choice,’ she says.  ‘Cataract surgery is a short procedure, but is incredibly complex and has risks. The idea of walking straight out of surgery into a busy shopping centre on a Saturday afternoon is horrifying.’ Bupa’s 2.5 million policyholders may soon find themselves facing similar predicaments.

Soaring hospital and medical costs mean private medical insurers are desperately looking to find ways to slash costs.  Premiums across all private medical insurance companies have jumped 52 per cent in the past decade to an average of £1,070 a year, according to figures from analysts Laing & Buisson. Now insurers are looking at other ways to protect profits.

 

Patients have always had to top up the difference between their doctor's fee and what the insurer will cover

Earlier this year, Bupa slashed the amount it would pay for common procedures, ranging from hip replacements to hysterectomies, by anything from four up to 63 per cent. Patients have always had to top up the difference between their doctor’s fee and what the insurer will cover — but these cuts mean in some cases they will have to pay far more. The alternative is to see a doctor from a list of consultants who charge only the strict new prices set by Bupa so there is no extra cost to the patient.

Bupa says its move is to stop patients being hit with shock bills and to keep health insurance affordable so its members can continue to receive the most advanced drugs and treatment without their premiums rising. Members can chose from more than 10,000 qualified and experienced consultants whose fees are covered in full. But critics argue these doctors may be less experienced and willing to work at lower rates because they are desperate to build up their private practices.

Richard Packard, deputy chairman of private doctors’ trade body  the Federation of Independent Practitioner Organisations, says: ‘Cheaper doesn’t necessarily mean worse. 'We do not advocate unreasonable fees, but, as with most professions, if you have greater experience and are recognised as being more specialised there may be higher charges. In many cases, the insurers have made these changes in the middle of a policy year and the patient finds out only when they make a claim.  One of the major benefits of private medicine has always been the ability to choose consultants. This choice is being removed and it devalues the whole process.’

The Mail’s doctor, Martin Scurr, fears cheaper doctors might be tempted to jam in more patients to boost their earnings. ‘One of the key reasons for going private is so your consultant can take time to see you. But you may find those charging less “piling patients high and selling them cheap”. 'If they are seeing ten patients instead of five, there is obviously going to be less time to spend with each individual to discuss aspects of their care.’ Bupa says the changes are in the best interest of patients. It adds that consultants’ fees have remained ‘robust’ despite the recession, and a doctor with a private and NHS practice will typically earn £200,000 a year.

But critics argue the changes are little more than a money-saving exercise. Furthermore, Mr Packard believes it should not be down to insurers to decide prices. ‘When you pay for private medicine you pay for patient choice. It is about being able to see a doctor when you need to — otherwise you may as well quite simply go on the NHS,’ he says.  The alternative for someone such as Jacqueline Wigg is to have her procedure done at a branch of Optical Express, which already performs laser eye surgery.

The treatment will be carried out by experienced surgeons — though not all are NHS consultants. Bupa says of Optical Express: ‘We can guarantee that all members will be treated by Bupa- recognised consultants. 'As with all surgery, it is a requirement that patients undergoing cataract treatment are accompanied on their journey home. ‘Should someone require assistance, there is a chaperone available who will escort patients to their onward transport.’

Doctors argue that despite advances in medical technology, cataract surgery is still complex. ‘Cataract surgery is much more technically challenging than laser eye surgery and there are many more risks — it can be an operation that causes blindness,’ says Milind Pande, immediate past president of the UK and Ireland Society of Cataract and Refractive Surgeons. ‘In one in three cases, the patient undergoing cataract surgery already has other problems with their eyes and the risk increases even further. In those cases, they need care provided by a doctor.’

It’s not just eye surgery funding that is being cut. Accountant Graham Davies has been with Bupa for 25 years. So when after years of playing sport and running marathons, he began to suffer pains in his knees, he thought he would be fully covered for any treatment he needed. Mr Davies was referred by his doctor to a specialist for a routine operation called an arthroscopy — a tiny camera is inserted into the knee to investigate for damage, repair may also be carried out. He was prepared to pay £500 extra to visit a top consultant. But he found himself paying another £200 on top of this because of the cuts Bupa had made for his surgery. It had slashed the amount it would cover for arthroscopies from £589 to £335 — meaning Mr Davies had to find £715 for his £1,050 operation. ‘These changes were brought in weeks after I renewed my policy,’ says Mr Davies, 52, from Harrow, North London. ‘I am furious they moved the goalposts without my knowledge or informing me.’

Mr Davies has left Bupa and took his complaint to the independent complaints body, the Financial Ombudsman’s Service, who ruled Bupa was entitled to make changes. Bupa says Mr Davies was warned about the shortfall and was given the option of being treated without paying more. Bupa is not the only insurer that has tightened up on what it will pay for.

AXA PPP has imposed caps on a number of procedures and introduced a list of approved doctors. Policyholders who want to see a doctor on its non-approved list receive only partial funding. It says: ‘We pay the vast majority (97 per cent) of the fees submitted to us for treatment of our members in full.’ Bupa UK’s managing director, Natalie-Jane Macdonald, says: ‘The only source of money we have to pay the healthcare cost of members unlucky enough to be ill is members’ subscriptions. ‘We’re in a tough economy and affordability is really important. There is no evidence to suggest consultants who charge more deliver better outcomes. In terms of length of experience, of more than 10,000 fee-assured consultants whose costs are covered in full by Bupa, the average age is 50 — the same as the average age of our non fee-assured consultants.’

Bupa also says it has increased the fees surgeons receive for certain procedures. But after paying £50,000 over the years to Bupa, Jacqueline and John Wigg feel the firm has let them down. The insurer has rejected their complaint saying many of its consultants would have undertaken Mrs Wigg’s operation for the insurer’s standard fee. The procedure takes only 15 to 20 minutes, and it says that it could see ‘no justification’ for the fee her consultant was charging. ‘The huge attraction of Bupa to us was choice,’ says Mr Wigg. ‘But what kind of choice is this giving us? Is this the thin end of the wedge? 'What will be the next procedure where the cost will be cut by two-thirds?’

 Source: Daily Mail UK 

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