BIBA calls for broker evidence for OFT review

It wants brokers to offer substantive evidence of consumer detriment to their clients caused by the relationship between private medical insurance (PMI) providers and healthcare suppliers.

Although the survey focuses primarily on the private healthcare sector, the OFT has acknowledged that due to the ‘critical input' of PMI it will consider the relationship between insurers and healthcare providers.

It suggests the review should include ‘the existence of any restrictions on the ability of consultants and other medical professionals to practice' and ‘how consumers access and assess information, and how they exercise choice in the provision of private healthcare.'

As a result, BIBA is preparing a reply regarding its concerns in the market that will be submitted once the review has formally begun.

Peter Staddon, head of technical services at BIBA, explained that examples of detrimental treatment to clients by providers utilising hospital networks or payment fee schedules were essential.

"Our group is very aware of the situation and I have been calling for evidence because I've got anecdotal evidence but I want substantive evidence," he said.

"I can understand the situation but what we need to be very clear is in showing that there's detriment to the consumer.

"Now the detriment can come in a number of factors, such as having a full reimbursement contract only to find the insurers will offer less money, being restricted from hospitals because they've decided mid-term to move the hospital from one category or another, or they are going to start deciding which physicians I can see?" he added.

Staddon also noted that if insurers alter their approach from the original agreed contract terms it could leave advisers open to compliance action.

"If a broker is selling a contract that has full reimbursement and the insurer only gives part of that, the intermediary is on the end of an errors and omissions case for selling a defective contract," he added.