Bupa has hit back at claims by doctors that its open referrals process is ‘flawed on several levels' and limits patient choice.
The insurer claimed recent findings by the Office of Fair Trading (OFT) supported its decision and revealed the majority of renewing corporate schemes were taking up the option.
It also noted that of more than 30,000 patients who used the process last year, 93% were comfortable with Bupa providing guidance and choice about hospitals and consultants.
The British Orthopaedic Association (BOA) has previously clashed with the private medical insurance (PMI) provider over its use of reviews for certain types of knee surgery.
However, in an open letter on its website, the BOA's Patient Liaison Group said it was ‘deeply concerned by Bupa's introduction of an open referral system' for corporate schemes.
‘It seems to us that the rationale given by Bupa is flawed on several levels because of the apparent lack of patency and the references to unpublished and unsubstantiated data,' it said.
‘In our view, there is no justification for the schism being driven between the patient and their GP; further, the implication that a GP may not know the local specialists, or what is best for the patient, is disingenuous.'
The Group also contended this was in contrast to NHS policy which intended to offer greater choice and questioned whether the desired effect of reducing those patients having to pay top-up would be reversed because any Bupa options might be too inconvenient.
However, it did accept that some patients may prefer guidance from their insurer but queried if this should be extended to all.
The letter concluded by saying Bupa should instead make it clear that every client has the option of either going to an ‘approved' clinician, or paying extra to go to one whose charges are outside the Bupa tariff.
It added there was a ‘risk of undue interference in the patient-GP relationship and that ultimately, the system may serve to limit patient choice'.
In response, Bupa said its clients were happy with the process and wanted to ensure patients would not have to pay any shortfalls for their treatment.
Katrina Herren, medical director at Bupa Health and Wellbeing, also cited the OFT's findings from its review of the private healthcare market as support for the policy.
"Recent research carried out for the OFT shows GPs often have limited information about a consultant's care practices, outcomes, patient experience, private patient charges or end-to-end costs of care," she said.
"This means that when our members need specialist care, they are often referred by their GP to a consultant based on ‘informal' information, and sometimes experience unexpected top-up fees from the consultant because they charge outside of Bupa's monetary limits.
"Open referrals offer increased choice for our members - rather than being referred to a single consultant by a GP, we provide our members with a choice of two or more consultants offering appropriate care at convenient locations.
"And if a GP feels that their patient should see a particular consultant, we are happy to discuss this; however our experience has shown that this happens very rarely," she added.
Herren also noted that additional or unexpected fees for treatment was one of the biggest causes of customer complaints and said the consultants that it used have an excellent record of treating Bupa members.
