AMII demands network data and fee transparency from OFT review

AMII recognised the benefits fee limits and hospital networks provide but said clarity was needed to ensure patients knew where they stood before receiving treatment.

Its call came as an initial response to the Office of Fair Trading's (OFT) review of the private healthcare market.

The Association said it believed the OFT should make a "clear distinction between broad-based ‘hospital networks', where the private medical insurance (PMI) policyholder has actively agreed to only obtain treatment at a selected list of hospitals in return for a lower premium, and the ‘treatment networks' where the insurer insists that for certain types of treatment the policyholder must use specific consultants or hospitals.

"These networks may be more restrictive than the general hospital list that the policyholder has bought into," it added.

AMII also requested an opt-out for policyholders if providers wanted to introduce a treatment network (albeit, at a higher premium) and urged insurers to share the quality data and criteria being used to establish these networks.

It added that greater transparency around benefit fee limits from insurers and the consultants and anesthetists themselves was desirable as too often patients were going ahead with treatment without knowing the full cost of treatment or if there would be any shortfall.

Michael Payne, general secretary of AMII said, "We welcome the OFT's study and will support it in any way we can.

"There are some very important issues to be looked at and anything that provides greater transparency and clarity for consumers of private healthcare can only be a good thing at a time when NHS spending restrictions are likely to increase the importance of the private healthcare market."

AMII had previously indicated to COVER that its response was likely to centre on the issue of data transparency, something it has now confirmed.