Good news for Private Medical Insurance.

House of Lords.

The Office of Fair Trading has announced a review into the Private Healthcare Market. Certain parties are “high jacking” this to draw attention to the habit in the Private Medical Insurance market of Insurers (most)  operating fixed fee scales for Consultants and Anaesthetists – which can have a significant financial impact on a policy holders medical claim.

The matter has even been raised in the House of Lords!!

Many policy holders may not be familiar with the term “fixed fee scales”.  By way of explanation when  referred by your GP to a Consultant you will be charged for the Consultants time, a number of insurers have put a cap on the amount they contribute towards the costs.  This is great news if your Consultant has signed up to the fee cap.   But what happens if they have not?  Well depending on the insurer you will more than likely incur what’s called a fee short fall, an amount of money the insurer refuses to pay and that you the policy holder must cover.

Insurers argue, reasonable, that their actions help reduce claims costs which in turn modify the premiums that policy holders pay. How ever the problem for the poor patient is that at the time of making an appointment they are unaware of how much the Consultant /Anaesthetist will charge. To be fair they have got to many other things on their mind at this time to believe that it is a priority.

Funnily enough the Consultant/ Anaesthetist will want to know if the patient has private medical Insurance in place, assuming they have then it is at this point the patient should be told about any likely fee shortfall. Regretfully this does not happen on a regular basis.

So how could these issues be addressed?

If every consultant agreed to fee scales then there would not be an issue.


More Insurers, particularly the larger ones could look not to apply the fixed fee scale.

It is in the interests of us all to find away forward so that we can maintain and increase the numbers of companies and individual who have or are looking to purchase private medical insurance.

Let us know your thoughts, as this is obviously a troubling matter within the Private Medical Insurance market.


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