About 11% of the people in the UK have private health insurance. There are many providers of this type of insurance, and they are understandably keen to grow their business whilst maintaining profitability. Over the last few years there has been increasing pressure from the insurers to move to ‘managed care’ which inevitably reduces the ability of patients to choose their specialist and preferred hospital. The following information from the Federation of Independent Practitioner Organizations (FIPO) explains what this might mean, and how to ensure that you get what you want. If you would like more information about this please contact me.
‘INFORMATION ABOUT REFERRING PATIENTS IN THE PRIVATE SECTOR
To All General Practitioners March 2010
Dear Doctor,
You may receive this letter more than once from various consultants and if so please accept our apologies. FIPO represents the profession in the independent sector and we are writing out to General Practitioners about some changes in the way in which certain insurers may deal with their subscribers when you refer them to a specific consultant.
Some insurers are implementing a ‘preferred provider’ strategy and whilst this may only affect a few patients who you refer for a private consultation or treatment you should be aware of the potential implications. It is possible that attempts will be made by the insurer at preauthorisation (when the patient phones the insurer to obtain authorisation to see the consultant you have recommended) to deflect the patient towards certain other consultants even though a specific consultant has been chosen by you, the GP and/or the patient. In some cases, the patient may have been under the care of their consultant for years and is then sent elsewhere. The reasons given for this deflection may vary but often it is stated that the consultant’s fees are too high.
Your patients should be warned to ignore this type of diversion as patients should always be able to obtain a fee estimate before deciding for themselves if they wish to proceed with their first choice of consultant.
Be aware that this is not in any way an attack on any specific insurer nor is it our intention to advise patients to change their insurance company. We are only asking that you warn your patients of this possibility. It applies to all specialties and whilst at the moment only a small number of patients may be affected there is an increasing trend towards this type of American styled “Managed Care”. All professional bodies have made it clear that patients should have the right to see the consultant of their choice and that they should not be diverted for any reason by the insurer. We hope that these types of restrictive networks do not take root because if they do then continuity of care and choice for GPs and patient will be significantly restricted.
In summary, please reinforce this message to your patients when you refer them for private treatment and make sure they insist on seeing the consultant of their choice. More information and also the FIPO Patients’ Charter can be seen on our website (www.fipo.org) and this defines the correct relationship between patient and doctor.
Thank you for your help
From the FIPO Board’
