News Update on the BUPA Ophthalmology Tender
August 6th 2007
BUPA Insurance has recently announced that it will be recognising 119 hospitals for ophthalmic treatment. Patients having cataract surgery in these “approved” facilities will be reimbursed the full and previously accepted BUPA rates for their consultant fees. This in effect restores the position to what it was 15 months ago when BUPA began this process of speciality tendering. The basis for BUPA approval of a hospital has not been defined to our knowledge.
If the patient, however, decides to go to a “non-approved” hospital or facility the reimbursement will be approximately 50% for the consultant fees and thus the patient will be penalised.
Whilst this is a big step back by BUPA Insurance from their original proposals which envisaged package pricing and more control of the referral pathways it is not as yet satisfactory because many hospitals including (at this precise date) the whole BMI group (the largest in the country) have been excluded from the “approved” network.
In some areas of the country there are very few (if any) “approved” options available for BUPA subscribers to have their cataract or eye treatment. This means that many patients are being referred to awkward or distant locations for their treatment, often under a consultant who is not their first choice. Furthermore, consultants have to plan their operating lists with patients who are insured by other companies as well as BUPA. They have found that they sometimes have to move all these patients to an alternative “approved” location in order to try and accommodate the BUPA subscribers on the list.
FIPO hopes that the BMI/BUPA dispute can be settled quickly because patient choice and reimbursements are obviously affected by the exclusion of these hospitals.
As part of the response to BUPA’s previous suggestions of poor quality in UK ophthalmic surgery (suggestions that have been vigorously refuted) FIPO has set up a national cataract audit in the independent sector, details of which can be found elsewhere on this website.