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Doctors Preference


Choosing a Medical Insurance Company

Our recommendations: It is perhaps no surprise that they are both mutual Associations.

WPA: Western Provident Association: http://www.wpa.org.uk/about/about-wpa.aspx

The Exeter Healthcare: https://www.the-exeter.com/health-insurance

Perhaps it is important to remember the reasons for taking out private medical insurance. It is often promoted by the insurance industry or private hospitals that the reason for seeking private treatment is the environment of a private hospital or the quality of the food. Alternately a policy may include a discount at a local gym or health check. However one must remember that the overwhelming reason should surely be to obtain the best medical outcome from treatment for a medical condition when it arises. This should be the area within the policy of greatest interest. The outcome of treatment relies primarily on the choice of specialist, the facilities available to them and the success rate. In terms of surgery this usually relates primarily to a low complication rate, low infection rate. Whilst in respect of cancer treatment 5 year survival and cure is highly relevant, in respect to orthopaedics and joint replacement the 5 or 10 year revision rate or incidence of deep infection is most important.

Therefore it seems that the reasons for choosing an insurer would be:

  • Your freedom to choose the specialist and facility of your choice without being “managed” or restricted by your insurers network
  • The insurers network includes all local consultants and hospitals without being restricted to their provider “network” or “partner” specialists.
  • A high level of specialist remuneration without risk of insurer shortfalls
  • A easy claims system without bureaucracy
  • A annual policy renewal without excessive increases in costs due to age or claims history.

A recent survey was circulated which claimed that 75% of medical specialists would recommend WPA to their patients as the medical insurer of choice. WPA has a less restricted network of specialists and therefore allows greater freedom of choice for their insured patients. The claims process tends to be much simpler with a significantly higher level of remuneration allowed for the medical specialists. This allows WPA to utilise a wider number of specialists and hospitals with less administration which possibly explains why WPA is preferred by medical specialists.

The WPA web site  http://www.wpa.org.uk/about/open-referral.aspx  :

“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 open referral (restricted referral – where some insurers direct patients to particular consultants) – is a contradiction in terms: private medical insurance is an elective purchase, giving policyholders the freedom to choose.”

“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.

Some insurance companies are increasingly utilising a “managed care model” restricting the patients choice of specialist or hospital to their narrowly defined network of “partners”. This includes BUPA and AXA-PPP. Others allow patients much more freedom in choosing their specialist and in covering their medical fees without “shortfalls”. These may include WPA and Exeter Healthcare.

Medical insurance may be provided by your employer or company. The employer often has the power of scale to negotiate preferential rates, extent of cover or for the payment of all medical specialist fees of your chosen practitioner without any shortfalls. Where there is any dispute often the company manager can resolve the issues more easily than occurs with personal insurance policies. However, the inland revenue treats the benefit of the policy as taxable and adjustments will be made within the tax you pay. Generally, it is beneficial to have a corporate scheme. Difficulties may arise when leaving a company, changing jobs or insurers where cover for recent problems may be reclassified as pre-existing to the new insurer and excluded.

Selecting the Extent of Cover

When selecting the standard cover of your health insurance, you will then have the ability to tailor a policy to suit your needs and find the peace of mind you deserve.

Through a diverse range of products and modular options you can add different levels of cover, whilst keeping the policy affordable for you. These various options may include;

Out-patient Cover
Comprehensive Cancer Cover
Mental Health Cover
Therapies Cover
Differing Excess levels
Hospital network lists
Restricted consultant and specialist “networks” or “partnerships”

It is your choice to design your cover either carefully selecting the options most important to you or deciding to take a more comprehensive approach.  If your concern if to obtain the best treatment and the local specialist of the your choice then a policy not restricted to a selected network of specialists or hospitals should be chosen. Some insurers have much higher levels of remuneration for specialists than others. The standard remuneration for Arthroscopic knee menisectomy, Total hip replacement and Total Knee replacement should be compared between insurers. The schedule for WPA: generally the highest level of remuneration appears at: http://www.wpa.org.uk/medical/feesearch.aspx   You may find that some of the other insurers are less forthcoming with their schedules and less willing to identify the amount they will pay in advance.