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BUPA commonly incorporates within it’s policies a restricted network of consultant partners selected by agreeing to a limited schedule for specialist fees. The claims process is usually “managed” by BUPA rather than allow a free choice of specialist experts of your choice of that of your GP.
BUPA is a Provident Association established almost 80 years ago as the British United Provident Association UK. The charter identifies that the assets of the association would be used for the medical treatment and benefit of its UK members. Members are all the holders of a BUPA policy. The health Insurance policies are annual policies so membership is renewed annually at the time of policy renewal. There are no shareholders. However the management board reports not to any shareholders or indeed not to the members who have no control, authority, or vote. The management board is responsible to a board of 96 “Associate Members” who approve the annual accounts and management proposals. The little known catch is that the 96 “Associate Members” are appointed and may be dismissed by the management board. They are comprised of 50% past BUPA executives and 50% selected members of the medical profession. The management board appoints its own remuneration committee and is not responsible to any shareholders, members or any annual general meeting.
In the UK BUPA has divested into an extensive network of care homes, Health Screening and corporate care. It provides international and expatriate Medical Insurance. BUPA sold its network of hospitals to Spire Healthcare. BUPA retains only one hospital the Cromwell Hospital in London.
BUPA has evolved, over many years investing the profits from its UK members such that it is now the largest provider of healthcare insurance in Spain, Hong Kong and Australia. BUPA is a complex corporate group of companies with a myriad of international and offshore holdings. Is this strictly in accordance with the Provident Charter to benefit its UK members? BUPA used to provide medical insurance in the Republic of Ireland. However, the Irish government altered the rules to ensure that elderly patients or those with chronic health problems were not left for the NHS to care for. The new rules meant medical insurance policies are long term investments as long as premiums are paid, and not annual policies subject to approval, renewal and the costs adjusted depending on the claims made in the year. Unlike AVIVA, BUPA no longer offer policies in Ireland. Patients over the age of 65 regularly complain that the annual increase in their policy premiums may be as much as 50%. They are often enticed into accepting alternative policies with ever more limited and restricted cover until most patients then cease to have medical insurance just at the time in their lives when they most need it and are most likely to make a claim.
In respect of Medical Insurance BUPA is the largest UK health insurer with approximately 45% of the market making it the market leader and a monopoly. BUPA has been proactive in introducing and promoting a “managed Care” model for many of its personal and lower cost policies. Some corporate, executive and premium schemes retain the freedom of choice for the patients and their GP to make consultant referrals on medical grounds. Thus BUPA policy holders are asked to contact the insurance “helpline” to arrange for treatment when their care will be “Managed” to specialists and facilities within their restricted “network”. Some insurers and the medical profession think that this is wrong and results in unforeseen hurdles and a restricted medical care, which may be “less effective treatment”.
The WPA web site refers to the implications of a closed referal 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.
When falling ill or having an accident as a BUPA insured patient, 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.
BUPA has a vast range of medical Insurance policies including personal policies, corporate, executive and international polices. These provide for various areas of cover and at various levels of specialist remuneration and network restrictions. BUPA has established a selected network in respect of consultants but also therapists, physiotherapists and hospitals. The perception is that this is to contain costs and the practitioners are asked to agree a defined restricted level of remuneration when treating BUPA insured patients. BUPA also provides to specialists a “Maxima” fee remuneration schedule. However this schedule is not applied to all specialists nor to all policies. Some corporate, BUPA managed, International and executive premium policies provide for payment of all medical specialist fees in full irrespective of the chosen specialist or therapist. The “maxima” schedule is not readily available from its web site for the public and its members so comparison of cover for specialist fees cannot easily be compared with other insurers. In general, it is lower than that published by others such as WPA.
British United Provident Association UK
Telephone number: 0808 159 9836
Web site: http://www.bupa.co.uk/health/health-insurance