FIPO has not provided an ongoing review of this complex matter over recent years due to the rapidly changing scene and the CMA Inquiry. The current patterns are becoming clearer.

The introduction of “Fee Assured” consultants coupled with “open referral” has become mandatory by most private medical insurers (PMIs) for newly appointed consultants and increasingly for established consultants. This matter was not explored in depth by the CMA as the role of the PMIs was not within the CMA’s remit.

Certain insurers are introducing new methods of “recognising consultants” based on their general costs, clinical outcomes and patient satisfaction. The precise outcome measures being monitored is unclear and it seems likely that fees will be the predominant feature which may disqualify consultants from a PMIs list of approved consultants.

AXA-PPP New Approach on Fee Reimbursements to Consultants (March 2010) and
FIPO’s Consultant Survey Response to the AXA PPP Initiative (May 2010)

The AXA PPP Letter to Consultants March 2010

Many senior consultants have received a letter from AXA PPP suggesting that they should comply with a new fixed fee schedule issued by AXA PPP and which is exactly the same as the schedule enforced on newly appointed consultants for the last 18 months. Broadly speaking the fee reimbursements for patients are lower than current BUPA rates. In addition, many consultants who had previously agreed a level of fee reimbursements with AXA PPP have been told that this is no longer applicable and that the new lower fee schedule will apply.

The letter sent to these consultants’ also states that they should give patients an estimate of their potential fees and FIPO would agree that this is appropriate. However, there is also the clear implication that AXA PPP will make patients aware of their potential shortfall which will, of course, be increased if the consultant fails to agree to charge at this new low rate of fees as the reimbursements to the patients will fall under this new schedule if they insist on seeing this consultant of their choice.

Consultants are concerned that this will penalise some patients and at the same time they do not wish to break the traditional contract they have with the patients who are ultimately responsible for their own fees.

Consultants are also concerned that patients may be diverted to alternative specialists at preauthorisation. This may not always be clinically appropriate and it may destroy continuity of care as patients are diverted from consultants who have treated them previously.

Anaesthetists are being targeted as well and so there is a threat that clinical teams (surgeon and anaesthetist) may be broken.

In order to assess the full implications and professional reaction to this new AXA PPP strategy FIPO conducted an on line survey of consultants.

General review of the FIPO Consultant Survey (May 2010)

Detailed results of the FIPO Consultant Survey (May 2010)

GP Information

The GP to consultant linkage may be broken in some cases by this AXA-PPP initiative and it is, therefore, important that GPs are made aware of the fact that their referral might be diverted to another specialist. FIPO has issued an advice note and a specific letter for GPs which can be sent out by consultants to their GP contacts. We hope that this will enable GPs to forewarn patients in advance of this problem. Consultants can download this advice sheet and the letter and can then send it to all referring GPs.

Read the GP letter that can be sent from Consultants

Read the GP Information Sheet