AXA – PPP Healthcare
Our rating: 3 / 10
AXA-PPP operates a strictly policed, limited and restricted network of specialists based on cost. There are bizarrely two different AXA-PPP schedules of fees for specialists. One (higher) fee schedule for doctors signed up to only charge what AXA-PPP proscribe and a lower fee schedule for specialists who do not sign up to only charge within the AXA-PPP schedule. It should be noted that recently the AXA-PPP fees for common Orthopaedic Surgery procedures has been significantly reduced.
PPP or Private Patients Plan was initially established in London by medical practitioners to provide medical insurance for patients. Subsequently this was bought by AXA insurance a French insurance company and AXA-PPP was established. Recently AXA-PPP bought BCWA or Simply Health another small provider of medical insurance. AXA-PPP is the second largest provider of medical insurance in the UK and has a market share of greater than 25% making it a commercial monopoly or duopoly with BUPA.
AXA-PPP manages a very tight limited network of approved consultants which may be placed into one of two groups. Those qualifying since 2008 have to agree to a limited network schedule of fees in order to be recognised at all. Older consultants and those more expensive consultants have their fees limited according to a different schedule of fees which is termed the “Fee Limited” list. The fee limited list is at a lower level of fees. AXA-PPP preferentially direct patients to the practitioners on the fee approved list. AXA-PPP also publish to specialist on their web site other conditions by which they have to abide if treating AXA-PPP insured patients:
“We publish two Schedules of Procedures and Fees that apply to different Specialist recognition statuses (Fee Approved / Fee Limited). We also undertake regular audits of claims submitted by Specialists and will consider de-recognition should anomalies be identified. Failure to comply with the terms of recognition, including but not limited to the fee reimbursement limits will be taken seriously and may result in temporary or permanent withdrawal of recognition by AXA PPP healthcare for benefit purposes.”
“Specialists must not ask our members to pay any additional amount themselves. The only exception to this is where members have a policy excess or co-payment policy – in these circumstances the benefit statement which will accompany the remittance advice will indicate that an excess or co-payment has been applied. Members will therefore be responsible for payment of the excess or co-payment but only to the maximum of the applicable charges set out within our Schedule of procedures and fees.”
More recently AXA-PPP have followed BUPA in establishing a “managed care” model for some policy holders. AXA-PPP continue to provide corporate, premium and international policies which may not be restricted in the same way.
The WPA web site refers to the implications of a closed referral system: http://www.wpa.org.uk/about/open-referral.aspx
“We believe that this should be a clinical not a commercial decision.”
“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.
Consultants´ attitude to ´open referral´. The Medical Profession is highly critical of restricted referral and its negative impact on patient care. We agree.”
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.
A recent survey of medical consultants showed that Consultants´ attitude to ´open referral´ was highly critical of restricted referral and its negative impact on patient care. 87% of consultants responded that Medical Insurance Policies which restricted choice of consultants, utilised network or partnership arrangement restricting the choice of consultants on a cost basis, resulted in “Worse” or “less effective treatment”.
Consultant research commissioned by WPA and conducted by independent market research specialists – GfKNOP. 1086 UK Consultants, Surgeons & GPs engaged in private practice were surveyed in December 2012. 591 responses (54%). For further information: http://www.dailymail.co.uk.
In order to retain your freedom to chose the best treatment plan for you. When falling ill or having an accident, you should seek advice from your GP or a medical specialist as to the most appropriate treatment and who the most appropriate specialist would be. You may telephone that consultant to inquire as to his charges for consultation and a possible operation. Armed with this chosen treatment plan and costs estimate it would be advisable then to check with your insurer as to what the level of remuneration and reimbursement would be. In this way trying to maintain your choice based on expert care rather than an insurance managed network.
Phillips House, Crescent Road, Tunbridge Wells, Kent TN1 2PL.
Telephone number: 0800 132203
Web site: https://www.axappphealthcare.co.uk/