What do you do when you see an experienced Consultant Neurosurgeon and he agrees to perform a procedure but tells you that BUPA have slashed the reimbursement for it by almost half and that you'll have to pick up the shortfall? It seems that a call to BUPA gives you the option of two alternative newly qualified consultants - who have only done a small number of these procedures in the past so can't be classed as "experienced". Actually, one of these was actually an orthopaedic trauma surgeon whose specialist interests really lie elsewhere!
Seems if you chose BUPA then you chose a company who will give you limited choice of specialists - or you'll have to pay a significant shortfall with others (and I'm taking about having to fund perhaps 50% or more yourself!) They now have the worst reimbursement rates of all the major providers by a huge margin. Moreover, they are clamping down on the types and number of procedures you can have in the lifetime of your policy.
Badly done BUPA!!!...and my advice to the rest of the public who are blissfully unaware of the changes that BUPA have made? I'd suggest going with another insurer!
BUPA will take your money but not cover,things like spinal injections for pain. Choose another company.They are misleading people.
We've held a bupa family health insurance policy for over 10 years but here is why I'm changing health insurer:
1. I'm spending too long on the phone to advisors - my record is 40 minutes
2. Incorrect information sometimes given about providers - this seems to depend on which advisor you get to speak to.
3, SHORTFALLS ABOUT TO GET WORSE!! Beware - from the 21st May, BUPA are introducing a new schedule of procedures (this basically details how much they are prepared to pay the consultant for each procedure). Most of these limits have been static for 20 years - yes that's why some consultants charge more and you are left paying the shortfall. But things are about to get worse. From 21st May, many procedures have been "downgraded"by BUPA meaning limits will be cut further - some by 45% or more - leaving you to pay the difference. For example, if your consultant wants to see you for a follow up consultation at which he wishes to perform a soft tissue or joint injection - BUPA will only reimburse the consultant £50 from 21st May (down from £91). This is because BUPA will not pay a consultation fee alongside a pre-authorised procedure. Indeed, the consultant would be better off just charging for a follow up consultation (and no injection) since he/she could claim more from BUPA....but as a policyholder, that would deplete my outpatient benefit pot! I think that this is derisory to the consultant (I can pay more than £50 for a hairdresser's appointment!) and unfair to policyholders because we'll end up paying for a reduced level of cover and end up paying increased shortfall amounts to the consultant directly!
4. BUPA are trying to introduce an open referral system - ie, allowing the GP only to make a referral to an un-named specialist (e.g. an "orthopaedic surgeon". BUPA will then allow the patient a limited choice of consultant which undoubtedly will be based on cost. So if you need a hip replacement and the most experienced surgeon in your area is not on their list because he is not as cheap....you may have to see someone else. Since newly recognised (and hence, less experienced) consultants have to agree to charge no more than BUPA's fee limits in order to be "recognised", it seems that this is where BUPA may try to force patients to go.
In summary, the brand leader is compromising what it is offering. Yes, BUPA have made investment losses during the recession and may need to boost dwindling profit margins, but this is not the way to do it! If you've ever had a breakdown of your account, the amount that the consultant charges is usually a small fraction of the bill with the bulk of the overall amount being billed by the private hospitals themselves for use of the facilities/support staff. It is the latter that they should be trying to contain!
BUPA are not writing to patients to explain that they are effectively reducing the amounts they are prepared to pay out - they have written to the consultants themselves, so until you need to make a claim, you'll be blissfully unaware of all of this as you are paying your premiums each month.
For that reason, I'm about to make a change to one of the smaller insurers (probably WPA) who are not indulging in the same tactics.
I have two procedures due, have been paying for years, I was told to pre authorise everything which I did and I have the pre- authorisation letters. I absolutely followed their procedures to the letter; they told me on the phone also that I was definitely covered for the procedure
Today i received a letter from BUPA, they are refusing to pay the first procedure that they authorised, notes 1 and 2 note 1 states " Under the terms of the scheme no benefit is payable" Note 2 states "under the terms of your scheme we are unable to pay this claim as prior pre-authorisation is required"
So after confirming tht my treatment was covered and having the pre-authorisation letter sitting in front of me the nice people from BUPA are trying to wriggle out of it.
This seems like a total rip off to me,
So now I'm supposed to have an operation in two weeks, I have the letter from BUPA pre- authorising but I daren't go through with it.
If you value your health I would AVOID
I have been with Bupa for the last 15 years, first in Spain with their sister company Sanitas and now here in the UK.
My experience has been positive and I have been very pleased with the care I have received from them.
Depending on the medical condition, once referred to the specialty (eg dermatology, gynaecology, etc.) the appointments are usually arranged within a few days and any tests (blood, ultrasound, MRI etc) then can follow quickly. Results will usually come back within a week and, if surgery is required, the waiting period is relatively short - in my experience less than a month.
There is an approval process depending on the insurance cover you take out but the authorisation can be done over the phone.
The Clinics and hospitals appear to be very well equipped, clean, and in my experience the nursing and other medical staff have been polite as well as professional in their approach.
Many years ago when I lived in London a friend suffered a nasty double fracture of their leg, not exactly life threatening but not exactly pain free and as a result then ended up in a London hospital, when I went to visit I was shocked to find that they had spent the first eight hours of their stay on a trolley in a corridor, now it was a Saturday night and very busy but the care they got over the next couple of days was not exactly great either, that Monday I returned to work and signed up for the companies BUPA policy which was at a 50% reduced rate and I have been a customer off and on ever since.
Currently I'm rather fortunate to get BUPA free with my current employer, they see the benefit of reduced time away from the work place saving them the cost of a replacement teacher and I get the benefit of health cover at a vastly reduced rate as the only cost to me is the benefit in kind adjustment to my tax code at my marginal rate of tax. Last year the company scheme was deemed to be a benefit of £480 so I effectively paid tax at my marginal rate on that amount which represents a huge saving on the actual cost. It is not possible to get a cost figure for the actual cover I have from the BUPA website as the company offers four levels of cover in all and you have to apply for a quote for each of them however you are able to reduce the cost of cover by selecting a higher excess, on my particular policy there is no excess so I get the full cost of any treatment paid.
Many people would argue that there is no need for such cover as the NHS is free at the point of consumption, it offers an excellent service and you have already paid for health cover in your taxes to a great extent I would agree with those opinions having been a customer of the NHS on a number of times my personal experience has always been very positive. So why choose BUPA? Well maybe my last two experiences of needing treatment can illustrate this. About six years ago while without health cover I ruptured my Achilles playing squash and was rushed into hospital where I was operated upon, in all I spent three days in hospital on a shared ward and the experience was perfectly acceptable, the only complaint I would have had was on the quality of the food and the fact that I was left for long periods with a lack of nursing cover. When I came out I needed physio after the cast had been removed and when that time came I had to travel to Daventry for it which is a 25 minute drive all because of some arcane NHS structure that made no sense to me. To be treated locally I would have had to go private. I also had to wait six weeks before I could start physio and the sessions were in small groups so you did not get the undivided attention of the physio.
Jump forward to more recently and my experience with BUPA. This time I aggravated an old knee injury while playing hockey. Initially I had physio treatment however over the Christmas period it became apparent that the knee was not improving and the physio referred me back to the consultant. On the Monday I rang BUPA and they issued me with an authorisation code. That same day I rang the consultant and was given an appointment for that evening after work (you see the benefit to my employer) I was booked in for a CAT scan on the Wednesday night, a further consultation on the Thursday night where surgery was recommended and then I had control over when the operation was done which again minimised the time spent off work as I have used this half term to recover. My follow up appointment will be next Monday and I will probably be back with my physio by the end of the week. Now compare that with the weeks you would wait just to see a consultant in the NHS for what is a fairly minor condition i.e. not life threatening, let alone a surgery slot and what have you learnt?
Well I guess first off given my history maybe I should take up less physical sports but also with BUPA you are paying in part for speed of treatment and the fact that you do not have to deal with waiting lists. That for me is the key benefit, life to short not to be in the best possible health and the sooner you get treated the better.
The claim process with BUPA is incredibly simple, I had originally gone to my GP and told him that I was with BUPA, he issued a referral letter and I contacted BUPA immediately by phone, they then issued me with an authorisation code and the phone number of the consultant I needed to see. All the way through the process everything was done by phone with no forms to fill in, all of the bills are settled directly and I get a conformation invoice to show this. At each stage if any new treatment is needed all I do is contact BUPA to discuss it with them and then provided it is covered they will pay the bill and I have found the call centre to be very efficient and helpful especially when it came time to have the operation on my knee.
Funny enough while in hospital, which was only a day surgery, I did not get the private room you are entitled to as the private hospital in Northampton is under going development and hence I was on a shared ward with two other patient however this mattered little to me. It was clean, efficient and one nurse was assigned to the three patients so plenty of attention, plus you got a menu at the start of the day and the food was prepared individually and came hot whenever you wanted it. Personally I was not hungry after the op but you had to eat something before leaving and it was very tasty.
For me having BUPA is a no brainer, I have nothing against the NHS it is just that I appreciate the benefits that cover provides, would I be able to afford it without getting it through my company? Probably not but it is something I would consider. There are various levels of cover and also they have a self pay option for private treatment. My knee problems have probably run up bills close to £6,000 with all the physio treatment that I have had and will have over the next couple of months so self pay in not really an option. Also the treatement you have is locally sourced and at your own convenience, my physio specialises in sports injuries and particularly the knee joint which is very relevant and important to me. The consultant was excellent and happy to spend time pre and post op explaining what has been done and was comfortable answering my questions.
BUPA are the best known of all the health care providers and the only one I have experience of although there are plenty of others out there. Check out the Money Savings Expert website for advice on their relative strengths before taking the plunge as you can save money with some intelligent shopping around. The BUPA website is www.bupa.co.uk.
Thanks for reading and rating my review.
I've recently left Bupa, working there as an advisor who specialised in policies that an individual would purchase as opposed to someone who got their cover through a company they work for.
Overall, I would say that Bupa is a company that really does it best to try and do best by its customers and a customer-centric approach was obvious.
In terms of the policies it sells, some are great - some are rubbish. Of the new 'Heartbeat' policies, introduced in around 2003, Healthcare Select 1 and 2 are the policies one should be looking to buy as these give you full cover on consultations. Anything below that and you end up paying for your ALL your consultations (£150-£250) that take place before daycase or in-patient (NOT out-patient) procedures. When you take into account that you could still be paying over a £100 a month for the cover on these lesser policies, the policies start to look useless .
And you might have an excess. So if you pay for a £200 consultation, that would not form a part of it - you'd still have to pay £100 on something like your x-ray or blood test. Starts to look bad.
However, you do get to see a consultant straight away. You get your tests asap, you get to choose when you have an operation if you need one which is great for people who work. The cancer care is second to none as well and unlike many other insurers, Bupa will fund palliative treatments should the worse come to the worse. If it's these sorts of things which you're concerned about, Bupa is a must otherwise it can be very costly before it even pays out.
In summary - don't get anything less than Healthcare Select 1 or 2 if you're going to have an excess. If you go for Healthcare Select 3, don't have an excess. If they try to sell you anything lower, tell them no. My final piece of advice is to try a broker or go through the company you work for if possible as you do get big discounts.
BUPA are one of the best known private health insurance companies in the country and my experience of using them has been a really positive one. I'm actually covered through my boyfriends policy that he added me to so I'm not sure how much it costs each month as he gets a discount on the cover through his work.
I had to provide some personal details when I was added to the policy as well as previous health information as pre existing conditions would not be covered.
With private health cover you are paying for peace of mind that if anything goes wrong you will have access to a consultant immediately rather than having to wait for the NHS to see you which can be months.
Recently I started getting some pain in my knee joint probably caused by my dancing so I went to my doctors, stated that I had privet health cover and immediately they gave me a referral to a consultant and a letter to provide to BUPA, one call later and immediately I had been accepted that my costs would be covered and I was given the go ahead to make the appointment.
Everything has been so easy, I was eventually referred to physio and all my bills are paid, so far I reckon I have easily run up a £500 bill which we ould not have been able to afford and everything is paid directly by BUPA, each physio session is £39 and a fifteen minute follow up with the consultant was £75.
For peace of mind BUPA certainly are well worth the expense.
I work for a private practice in London and it is my job to liaise with insurance companies to determine whether our patients are covered for various procedures, consultations and operations. I also deal with the undesirable phenomenon known as "shortfalling" which I will explain later. Having spoken to BUPA and other insurance companies on a daily basis for the last year and a half, I would like to share my knowledge and experience of BUPA.
I am not a policyholder of BUPA's and only call the claims helpline. This is LO-CALL number: 0845-7553333 based in Manchester. Generally you get straight through to a human voice after 20 seconds once a camp Mancunian voice has welcomed you to the "BUPA services helpline". I did a little of this over the week 14th - 18th September 2004 and went straight through to a human 72% of the time (62 out of 86 calls). For a call centre, I think that's pretty impressive.
In insurance terms, any hospitals, surgeries, consultants or operating rooms are referred to as "providers". In any other business they would be creditors or suppliers. BUPA and other insurance companies are viewed by the public as a financial, peace-of-mind body between the patient and provider.
A shortfall occurs when a provider's set charge for a particular procedure is "X" amount of pounds and the maximum the insurers are willing to pay is less than that. The difference is the shortfall and 95% of the time in my experience, the patient has had to foot this balance. Here are some tips to avoid shortfalls.
1. When seeking cover for a particular procedure always get an exact quote from the provider and, if applicable, something called called an OPCS code. This is usually a letter followed by four digits. Inform your insurers of the quote and code and ask how much they will pay towards it. I work in the treatment of breast cancer and shortfalls happpen about 50% of the time, so please check.
2. BUPA rarely send out claim forms for treatment in my particular field and instead use "authorisation codes". PLEASE note that generally their codes are valid for one visit (usually an initial consultation) unless otherwise stated. Any further visits or treatment you require from the provider may well need a separate code. I have known BUPA to refuse to pay us because a patient didn't get a code before her visit. The patient was, therefore, liable to settle her account personally, even though she was insured. Bite the bullet and DO AS THEY SAY.
3. Check your policy carefully and note any excesses. I know it goes without saying but BUPA will deduct the value of your excess from the first invoice they receive. If your excess is £100 and they receive, for example, a £125 consultation fee from a Harley Street clinic they will only settle £25 of that. It's stating the obvious, I know, but please be aware.
4. Beware of "unbundling". This is when two or more procedures are carried out at the same time and billed separately on the provider's invoice. BUPA will not pay for each OPCS code, only the major procedure and then 25% for the second and 10% of the third. This can also lead to a significant shortfall. When you quote you OPCS codes to them, check they won't "unbundle" your claim. It's a little-known hazard to the public and one that more people should be made aware of.
BUPA staff at the Manchester call centre are VERY helpful. Your policy number (two digits followed by a slash and another nine numbers) is generally all you require to enable you to talk about your account. They do a sensible security check and ask for your postcode and date of birth. For data protection, they will NEVER disclose your address to a third party: I have had to chase patients for shortfalls, found they've moved house and gone to BUPA who refused to help me. Annoying for me but reassuring for the policyholder, I'm sure. Apart from the treatment performed on the policyholder, no financial and detailed information about the actual policy is ever disclosed to a provider. Given the vast range of BUPA policies this must be reassuring in the sense that no one can tell how tight or flush you are!
BUPA keep their policyholders informed of any shortfalls BEFORE the payment is sent to the provider. A policyholder statement is sent showing the invoice details, date balance, "ineligible amount" (shortfall/excess) and amount paid to provider. The amount due to the provider from the policyholder is also listed on this sheet. At this point it is advisable to speak to the provider to confirm the shortfall and make arrangements for paying before the chase letter come.
Generally, I find BUPA a great company to deal with as a provider. They're courteous, informative and some of the "robots" in the call centre are actually rather human and knowledgable. Even knowing what I know about their policies and the advent of shortfalls, if I had to choose a health insurer, I would plump for BUPA.