‘Majority’ of specialists get fee rate questioned

By Robin Stride

Nearly six in ten consultants responding to a BMA survey revealed they had been challenged by private medical insurers about their fees.

The association’s annual private practice conference heard 57% had been quizzed over their charges and 30% had experienced a refusal to pay.

According to the BMA’s Private Practice Committee study sent to 10,000 consultant members across the UK (1,149 replies with just 379 independent practitioners):

 43.9% said they had problems with patients receiving treatment authorisation;
 31.8% had been threatened with derecognition by insurers;
 26.7% had experienced patients being redirected to a different consultant.

Just over a quarter of consultants reported cases where patients were given ‘derogatory/misleading’ information from their insurers.

Asked if the threatened derecognition had gone ahead, four said it had ‘on all occasions’, 18 said it had on ‘some occasions’, 74 said ‘No, never’ and – strangely – nine specialists said they did not know.

Over a third of consultants (35.6%) said they did not reduce their fees after a challenge, 22% did on all occasions, and 40.8% did sometimes.

Private Practice Committee chairman Mr Derek Machin admitted the survey responses were lower than he would have liked and said doctors should be circumspect about how much reliance was put on them.

But he claimed many of the figures were ‘a dreadful indictment of the insurance industry’.

A small minority of doctors admitted to cutting their fees below insurers’ limits since January 2016 ‘to improve competitiveness’, but 88.3% did not. Dropping fees, however, only resulted in more patients for around a fifth of those who did it.

Of a sample of 293 doctors, 40% spent up to 20% of their earnings on expenses, a third spent between 21-40%, 18% spent 40%-60% and 9% spent 60%.

Looking at changes in the proportion of earnings from the three main sources, comparing 2015-16 with 2014-15, around 80% of consultants reported self-pay, private medical insurance and NHS patients seen in the private sector had stayed the same.

But earnings from self-pay patients had risen for 39% (sample 304) and 38% for patients with insurer contributions (sample 323), and 17% for those seeing NHS patients in the private sector (sample 309).

Consultants were asked what impact various factors had on their private practice earnings in the last year. Restriction of availability of procedures in the NHS had led to increased earnings for nearly one in five, while longer NHS waiting times brought higher income to 30%.