Surgeons have condemned plans by Bupa to demand pre-operation second opinions as "unacceptable" and "potentially harmful to patients" while criticising the provider for not working alongside them.
UPDATE:The letter reffered to in this article has since been withdrawn by the BOA for legal reasons.
They also slammed the scheme as "financially motivated" and warned of "serious legal, ethical and General Medical Council (GMC) considerations for every consultant who has agreed to do this".
Under the plans, the British Orthopaedic Association (BOA) letter claims Bupa will demand a second opinion from its own or an appointed surgeon before giving the funding for members' arthroscopic knee procedures the go-ahead.
Bupa denied this was the case, instead suggesting it is a review of the available evidence.
The open letter to members, also signed by the British Association for Surgery of the Knee (BASK) and the Federation of Independent Practitioner Organisations (FIPO), is another shot in the battle between health insurers and practitioners.
Tensions are running high between the two parties with the Office of Fair Trading (OFT) conducting a review of the private healthcare sector, including some interactions with private medical insurance (PMI) providers.
The letter explained that every surgeon will have to submit a report on each proposed case and that Bupa reserved the right to review all the patient's private medical notes and the GP records before agreeing to fund the operation.
It denounced Bupa's plan, arguing that the "principle of a distant second opinion is unacceptable and potentially harmful to patients with many legal and ethical considerations for an outside assessor".
"It is inherently wrong to provide an opinion without examining the patient, and we are unable to make any recommendation for a scheme initiated by an insurer, which is open to many criticisms and which ultimately is financially motivated," it said.
The bodies also stressed that the PMI provider had not produced any clear evidence of inappropriate practice amongst individual surgeons and predicted "further actions by Bupa and other insurers in different clinical scenarios which would create an intolerable situation" for patients.
A response from the insurer was included, stating that the policy was being introduced only for funding reasons and that the procedure could still go ahead, although without funding.
Bupa also insisted it would be checking the surgeon's decision against guidelines and they are not second guessing the original surgeon's clinical decision, adding that the surgeon could appeal if they felt aggrieved by the result.
However, the practitioners' bodies were not reassured by that, saying: "we are unclear about the guidelines to be employed and in any event a guideline is a general rule or piece of advice".
The letter concludes by warning that this approach is modeled on similar systems to the USA where peer reviewed opinions are driven by cost rather than quality of care.
