THE 52% RISE IN YOUR PREMIUMS
Over the past couple of years the £5 billion-a-year private medical insurance industry has been hit by soaring costs. Returns from investments that these firms traditionally used to bolster their profits have plummeted. This toxic cocktail means insurers need to find some way to claw back cash — so ordinary policyholders are being forced to pay the price.
Health insurance premiums increase as you get older and make more claims, and have risen by 52 per cent to £1,070 a year, according to analyst Laing & Buisson.Some insurers are trying to offset rising drug and hospital bills by introducing new terms and conditions that exclude customers from claiming. This could leave patients having to dig into their own pockets to fund their care.
Not surprisingly, all this has gone down badly with patients. Figures from independent watchdog, the Financial Ombudsman Service, reveal complaints about private health insurance have surged 21 per cent so far this financial year. When accountant Graham Davies began to suffer pains in his knees, he hoped the Bupa policy he had paid for 25 years would cover him. Mr Davies was referred by his doctor to a specialist for a routine operation called an arthroscopy — a tiny camera is inserted into the knee to investigate for damage.
Cover for this had dropped from £589 to £335 — meaning Mr Davies had to find £715 for his £1,050 operation. ‘These changes were brought in the weeks after I renewed my policy. I am furious’ says Mr Davies, 52, from Harrow, North London.
Bupa says Mr Davies was warned about the shortfall. Common concerns include policyholders being unable to see the doctor they want or get the treatment they need.
A spokesman for campaign group the Private Patients’ Forum (PPF) says: ‘There needs to be a more intelligent conversation between some in the private medical insurance business and their customers. We hear many concerns from people insured as individuals or on company schemes.’
Eye Operations in a Shopping Centre
Choice over whom you can see and where you can get treatment is being whittled away. Some big insurers have introduced approved lists of doctors. In some cases, if a local specialist is not on your insurer’s approved list, you may have to travel to see one who is or pay extra costs out of your own pocket. Restrictions brought in last year by Britain’s biggest private health care firm Bupa are the most controversial.
It has introduced a list of approved consultants for business customers. And it has slashed the amount it will pay for common procedures, from hip replacements to hysterectomies, by up to 63 per cent. It means Bupa customers can no longer get treatment from surgeons who charge above this level without footing some of the bill themselves. However, Bupa says it will cover all costs if they use one of its fee-assured doctors.
Alternatively, the firm is asking customers to have cataract operations at branches of opticians Optical Express — often found in shopping centres or town centres — as part of a deal thrashed out in the past year. Bupa claims cutting fees is justified because operation times have fallen. It argues some doctors’ fees are inflated. It also says it has increased consultant payouts in a number of cases.
The British Osteopathic Association claims an estimated 800 osteopaths stopped accepting Bupa patients as a direct result of the changes. It claims the fees Bupa sets, typically between £30 and £50 a time, are lower than many osteopaths charge.
Bupa denies this and says it judges osteopaths on quality and value for money. It claims 190 osteopaths have left and there is no set fee.
Mark Pitcairn-Knowles, an osteopath from Sevenoaks, Kent, says: ‘I am furious at these changes.
‘A 93-year-old patient, whom I have been treating for 30 years, rang asking me to visit him. I explained that Bupa will not pay my fees. He was very cross, especially as he had paid a £1,700 premium the day before. ‘Understandably, at his age he does not want to see another osteopath.’
Experts say other insurers look likely to bring in similar changes. The British Osteopathic Association also says its members have not charged Bupa an inflated fee. AXA PPP, Britain’s second biggest insurer, has imposed caps on a number of procedures and introduced a list of approved doctors. Policyholders who want to see a doctor on its non-approved list receive only partial funding. It says: ‘We pay 97 per cent of the fees submitted to us for treatment of our members in full.’
Aviva, another big insurer, says it has a list of fee-approved consultants, and patients will have to pick up the shortfall if they choose another specialist. ‘Members are treated by consultants with at least seven years experience,’ says Bupa. ‘Fee-approved consultants are just as experienced as consultants who charge higher prices. We make no apology for ensuring we pay a fair price for treatment, which keeps premiums affordable.
Drugs Stopped After One Year
Cancer treatments are becoming ever more sophisticated, but their costs are spiralling. The NHS spends £1 billion a year on cancer drugs. A course of Herceptin, typically given to stomach cancer patients, is £10,000. There can be big differences between policies. Some insurers will pay for drugs in full, while others impose limits.
One way some insurers cut down on these bills is to make customers turn to the NHS first. Only if it’s not possible to get the drugs funded by the taxpayer will the insurer pay up. Those who do manage to get their insurer to pay up may find tight limits on their cover. Often these patients are told they will get treatment only over a set time — typically 12 months.
If they need longer they must ask their insurer to extend their treatment. If it refuses, they have to return to the NHS — often being forced on to a waiting list. A recent study from drugs firm Roche found nearly half of bowel cancer patients surveyed and more than a third of breast cancer patients had to plead with their insurer for extended cover.
So-called targeted treatments — a cocktail of drugs tailored to a patient’s own needs — are a lifeline for many cancer sufferers. But here, too, some firms are introducing limits on the amount of treatment they will cover, typically for one year.
Penny O’Nions, a health insurance broker, says one client recently fell foul of the rules. While a consultant had told her she needed another round of targeted drugs to treat her cancer, an insurer had turned her down. ‘She was absolutely distraught,’ says Dr O’Nions. ‘All she had wanted was to see her daughter’s wedding.’ Dr O’Nions eventually managed to win the treatment for the patient. Other insurers have limits on what they are willing to pay. Simply Health will cover up to £50,000 of cancer treatment over the policy’s lifetime.
£250 For Patients who’ll use the NHS
Including treatment, it can cost £3,000 a night for a stay in a private hospital — according to figures from insurer WPA. So firms are trying to shift these costs on to the taxpayer.
Patients are being given pay-offs worth hundreds of pounds for having their treatment on the NHS. PruHealth will hand you up to £250 every night you spend in an NHS hospital, up to £2,000 a year. Neville Koopowitz, chief executive of PruHealth, says: ‘We aim to provide our customers with as much choice as possible. That is why we provide the option of choosing NHS treatment and receiving a cash amount.’
Several insurers promise a cut in premiums in return for you having all of your treatment on the NHS, provided your treatment can start within six weeks. An ABI spokesman says: ‘Sometimes the NHS might be the right choice for you. The insurer is giving you something back because you have not cost them anything for private treatment.’