IMPORTANT INFORMATION FOR PATIENTS INSURED WITH BUPA
Dear BUPA Customer,
I’m writing to let you have some important information regarding your insurance with BUPA and the cover you have
for any potential eye surgery that may be required under my care. Unfortunately BUPA have recently unilaterally
changed the benefits of certain policies for some of its customers for certain procedures. These changes, which
were made in July 2012 without any prior consultation with their customers or with the Consultant bodies
concerned, have two important effects.
Firstly, BUPA wish to manage the choice of which doctor you wish to be referred to and treated by. Your treating
Consultant is traditionally either chosen by yourself, the patient, or by your GP, or sometimes recommended by your
Optician. It may be because you know someone else who had a good experience with that particular Consultant, or
that they have an excellent reputation. Your GP may advise you – they tend to know the local Consultants well, and
they will l also understand who specialises in which particular area. They will also have seen the results of surgery in
their patients treated by that particular Consultant. Optometrists are also in this position; they tend to see patients
after Cataract surgery for example, and know who is getting good results, and again who specialises in particular
conditions of the eye. For example, some surgeons specialise, as I do, in “premier” refractive cataract surgery using
premium replacement lenses, such as toric and multifocal lenses that can remove the need for wearing reading
glasses after surgery.
As part of this, I understand that BUPA have written directly to Optometrists asking them to not suggest referral to
Consultant colleagues that they may know to be competent (and sub-specialising in the area of the problem their
patients is suffering from) but instead asking them to refer the patient back to BUPA who will then chose a doctor
for the patient who is on their “price assured” list (i.e. someone who has agreed to perform the surgery for a
reduced fee). It appears that this doctor may not necessarily be a fully accredited NHS consultant or one that has a
particular interest in the condition that you are presenting with. It may be a recently appointed consultant who
being in the early part of their career feels compelled to agree to BUPA’s terms. BUPA are also referring patients
with cataracts to high street laser surgery chains for their surgeries. Finally BUPA has no clinical information about
you or which specialist it is most appropriate to refer you to for your particular eye condition. Leaving this choice to
BUPA who are making the choice entirely on cost in my opinion is completely inappropriate – we are talking about
an operation on your sight, not trying to get a good deal on a new car.
Secondly, BUPA have reduced the reimbursement fee (the amount the consultant is reimbursed by BUPA) across a
wide variety of specialities (not just Ophthalmology) and this means that it is very likely that you will have to fund a
considerable part of the cost of treatment yourself. As far as Ophthalmology is concerned, the reimbursement for
cataract surgery, and other many other ophthalmic surgical procedures, has been reduced by over 60%. This means
that whilst the fees that your consultant charges have remained the same (the fee for cataract surgery has not
changed significantly since 1993) BUPA will not be reimbursing the full amount. For Cataract surgery, the shortfall is
significant, and is approximately £600.
As doctors, the General Medical Council advises us that our “contract” (including any financial agreements for
private patients) is with the patient alone, and not with an insurance company. Any insurance company wants to
keep their costs down, and that is understandable, but when it involves removing patient, GP and Optometrist
choice, and directing patients to practitioners who may not be the best person to treat them, purely for a financial
reason (i.e. the cheapest) then that defeats the entire object (in my opinion) of having private insurance cover in the
first place. My over-riding responsibility is to you, the patient, and not to an insurance company. It is critical to make
sure that I can offer you what I consider to be the best possible treatment without being influenced by financial
decisions made by an insurer.
Some myths corrected: I updated this letter after I was shown some correspondence from BUPA, and thought it
would be appropriate to set the record straight:
Myth 1: “Consultants are just being greedy and it’s their ever increasing fees that have caused this problem”
My response: Not true – our fees haven’t risen since 1995 – and if you take inflation into account have decreased in
real terms
Myth 2: “Cataract surgery used to take one and a half hours, now it only takes 20 minutes and is a simple process”
My response: Cataract surgery never took an hour and a half. 30 minutes maybe – purely because some stitches
needed putting in. Modern technology has made the procedure quicker, but it is a technically exacting procedure
that punishes the casual surgeon. Patient expectations have risen exponentially, and we now take into account
complex issues such as spectacle independence, astigmatism, previous laser surgery etc. etc. This requires much
more “chair” time and sophisticated measurements beforehand.
Myth 3: “Cataract surgery is only worth about a third of what it used to be”
My response: It’s natural for any organisation to want to limit their costs, and also it’s in everyone’s interest to have
affordable insurance. The problem is that you can’t offer a private service for the fee that BUPA are now offering.
We have to cover administrative costs, costs of purchasing and maintaining medical equipment, insurance indemnity
premiums (significant!), professional body memberships etc. etc.
If you want to complain to BUPA
You can do this by phone and in writing. I personally believe it is wrong of BUPA to alter the benefits of your policy
without your knowledge and consent. It may be contrary to the terms of your policy (please read your own policy
carefully). Specifically BUPA undertake in a typical policy (“Making changes – Changes we can make”) to change the
amount and type of cover provided under the scheme only at your renewal date. Furthermore it is reasonable to
expect that at renewal BUPA inform you in detail of their proposed reduction in the value of your policy for many
different conditions i.e. provide specific and accurate figures – in this case the reduction in reimbursement for
cataract surgery (which has been in place and largely unaltered for 19 years). They should also have told you that
these reductions expose you to the risk that you may have to pay for some or all of your medical care yourself –
since the doctor you wish to see may not agree to these reduced reimbursements.
The telephone number of BUPA’s customer (relations) department is 0845 6066726 open 08.00 – 17.30 Monday to
Friday. You may email a complaint to BUPA on: www.Bupa.co.uk/contact. However it may be more effective to
write to the two most senior management executives. They are –
Mr Stuart Fletcher, Chief Executive, BUPA, BUPA House, 15-19 Bloomsbury Way, London WC1A 2BA.
Dr Natalie J. MacDonald, Medical Director, BUPA Health and Wellbeing UK, Willow House, Pinetrees, Staines,
Middlesex TW18 3HZ.
If you want to complain to the Financial Services Ombudsman
If you are not satisfied by BUPA’s response, you may wish to complain to the Financial Services Ombudsman.The
Ombudsman provides a free and user-friendly service. They may have the authority to direct BUPA to make
payment to you: www.financial-ombudsman.org.uk/consumer/complaints.htm
Financial Ombudsman Service, South Quay Plaza, 183 Marsh Wall, London E14 9SR
Consumer Helpline telephone 0845 080 1800
Further advice and be sought from the Consumer Association
Contact them by email: www.which.co.uk or phone 020 7770 7000
If you want to complain to the Competition Commission
The Competition Commission is engaged in a wide-ranging review of private medicine in the United Kingdom. They
accept submissions from members of the public. The two facts of particular interest to the Competition Commission
that you may wish to report are 1) BUPA’s attempt to change the terms of your insurance policy without your prior
knowledge and consent 2) It is very difficult to change insurance company despite your potential dissatisfaction with
BUPA. This is because a new insurance company will not necessarily provide cover for previously diagnosed
conditions such as your cataract. This traps you in an insurance policy that you now consider unsatisfactory and
provides BUPA (and other insurance companies) with the balance of power in the relationship firmly with BUPA.
Essentially it enables them to dictate the terms of your contract, leaving you little option but to accept whatever
unilateral changes they wish to introduce.
Please contact me if you would like further advice. This is best done via email – I can be contacted on
jonathan.luck@circlebath.co.uk.
Yours Sincerely,
Jonathan Luck