WPA to publish its fees for specialists

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The Independent Online
WESTERN Provident Association, the third largest private health insurer, is to publish details of how much its customers can claim for reimbursement of specialists' charges.

The fee table, which will be available in the next three weeks, is to be circulated to all consultants. WPA members will also be able to receive details before their hospital visit.

Forty per cent of the costs of private medical insurance are linked to specialists' fees.

Last month, the Government backed the Monoplies and Mergers Commission (MMC)'s recommendation that the British Medical Association should be banned from publishing its guidelines on fees.

BUPA, the biggest medical fees insurer, has published guidelines for many years. WPA's fee schedule will be broadly the same, although it will be paying slightly less for some procedures and slightly more for others.

WPA will allow a surgeon pounds 605 for a hysterectomy, with pounds 235 for the anaesthetist. The BUPA scale provides for pounds 589 and pounds 208, respectively.

A child's tonsillectomy warrants pounds 330 for the surgeon and pounds 135 for the anaesthetist with WPA. BUPA only pays pounds 289 to the surgeon and pounds 122 to the anaesthetist.

The MMC believes that its recommendations will bring true price competition between surgeons into the marketplace.

In reality, all it is likely to do is cause confusion.

Penny O'Nions, a doctor and a director of the independent financial adviser De Havilland, says: 'You can just imagine a consultant sitting at his desk with lists of different fee schedules from different insurers. He is busy working out how much he is going to get paid, while all the patient wants to know is, is he good at his job, regardless of the cost.

'Private health is a peculiar thing. People boast about how much the consultant charged, not how little. They tend to think the more they pay, the better the treatment.'

Private Patients Plan, the second biggest health insurer, reimburses for specialists' fees on a fair and reasonable basis.

PPP does not have any published guidelines and does not intend to supply any. It says its policy facilitates a free market.

However, 'fair and reasonable' is defined as what other specialists charge for a similar procedure.

Norwich Union, the market's other big player, has not yet decided on what basis it will now reimburse consultants.