The health insurance and protection market covered
Storm brews for clients over GP reports
A row is brewing involving doctors and insurers that may result in advisers and their clients being stuck between the two factions.
The conflict was ignited by insurers using data protection legislation to reduce the fees paid to GPs for medical reports and is likely to see clients being sent their full medical records by doctors following requests from insurers.
It stems from the termination of an agreement between the ABI and British Medical Association (BMA) on fees insurers should pay for requesting medical evidence.
As a result, according to a report from Pulse, the GPs news service, insurance companies are using data protection law to request the whole patient record for as little as £10 each, instead of the previous £97.
At present GPs are being told to comply with requests from insurers and send the file to patients, but to emphasise that the insurance company is not allowed to see the whole report.
This deterioration in relations has also prompted the BMA to seek legal advice on ‘the ABI's decision to scrap the deal on fees as it argues that the agreement is in the public interest'.
The article reports the £10 fee is a 90% reduction in costs compared with the standard fee for a medical report and comes with ‘considerable extra burdens on the practice, which has to first redact sensitive medical information such as HIV or smoking status, that is unrelated to the insurance claim'.
The General Practitioners Committee of the BMA recommends that if insurers insist on their current approach:
• the practice will have to send the report (subject to the usual exclusions) to the patient, with a briefing as to what the patient may wish to take out before sending it onto the insurance company,
• the practice cannot guarantee that the notes will arrive in the company's possession in the same state that they left the surgery,
• and the practice needs to be paid the fee up front.
It also highlighted the point that the Data Protection Act only entitles the data subject (the patient or client) to have access, not anyone else.
‘Although a lawyer is the patient's representative when instructed by the patient this is certainly not the case with an insurance company', it added.
Pulse originally learned that two unnamed insurance companies were using the Data Protection Act to access their clients' full medical records from a practice in Gloucestershire.
It added: "there are fears that this loophole could now be used more widely by insurers to reduce the fees they are charged by GPs, following the collapse of the agreement with the ABI."
Many insurers are trying to significantly reduce the number of GP reports (GPRs) requested and complaints have been frequently made about the length of time it takes doctors to return the information.
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Money for old rope really - time to change
It is good money for GP's but I doubt most actually do the work themselves except sign off the necessary documentation. I am sure they would prefer not to have to do this and so I better solution needs to be found and if many records are now in a digital format one would hope technology can be used here, so as other have said this needs action now and it does seem as if it has been badly handled by the ABI and others is it is causing delay and inconvenience to consumers.
Posted by: Michael fallas | Dec 02 2011
About Time!
Having worked for a number of years in a new business department at a major insurance company, this is a step in the right direction. I've often tried to negotiate with GPs and their surgeries only to me met with rudeness, a complete lack of interest and a refusal to complete the report for as little as £97 (we were always told that the ABI/BMA fees were suggested fees and they were not bound by them. Often they demand hundreds or they simply won't complete them - even asking that the sectrtary prints and posts the notes runs to treble figures). When the reports are eventually returned they are often missing some of the information we asked for, which means having to send another request, which means another invoice even though we've already paid! I once spoke two or three times with a GP trying to negotiate his (massive) fee down for information to be told he'd decided to charge us for the time he was spending discussing what he'd be getting for his work! We tried asking that they complete targetted reports for specific conditions - these take far less time so we offer less money. Response? 'We don't complete those sort of reports'. Any why? Because they can't charnge as much for them. Insurance companies pay millions each year for medical reports, which often takes months to be returned and are incomplete anyway. This will speed the process up and save huge amounts of money.
Posted by: Paul | Dec 02 2011
Make a Stance !
The ABI have probably reacted to feedback from the members to say generally how bad the service is from GP'S and at £90 a time very over generous. I recently had a case delayed whilst the insurer had to horse trade with the GP for a price for further information having already paid for the initial notes.This may bring them to the negotiating table !
Posted by: David | Dec 02 2011
Time for a new solution !
GPs are not seeing the real problem they cause for clients who are left without cover whilst they delay completing reports. The reasoning I suspect for using this route is not to save money but for the GP to be held to a turnaround time under data protection law to provide the info. We have lost cases where the doctors have first delayed completing the report and then not answered all the questions triggering a request for further information. One case even went over the generous total time allowed from application and had to be rekeyed!!! In this day & age with centralised records there is no reason a central body shouldn't provide reports - at £90 a pop you'd think this would be a winner during these cash strapped times ?!?
Posted by: Emma | Dec 02 2011
GP Data Protection Act fees
Not sure the journalist got their facts right. Medical Records under the Data Protection Act are specifically mentioned - and the fee is £50 and not £10. We do a lot of these types of requests from GPs without issue. Insurers cannot go on "fishing" trips - they must request a specific date range for what medical records they require and be prepared to justify this. For those who want the details please look at The Data Protection (Subject Access) (Fees and Miscellaneous Provisions) Regulations 2000 (SI 2000/191) & The Data Protection (Subject Access) (Fees and Miscellaneous Provisions) (Amendment) Regulations 2001. Certain subject access requests in respect of health records. 6. - (1) This regulation applies only to cases in which a request made under section 7 of the Act - (2) Where in a case to which this regulation applies, the obligation imposed by section 7(1)(c)(i) of the Act is to be complied with by supplying the data subject with a copy of information in permanent form, the maximum fee which may be required by a data controller under section 7(2)(b) of the Act is £50.
Posted by: Andrew Briant | Dec 02 2011
Sort this out
This is a real mess and as we know GPR's can cause real backlogs and stall cashflow. GPs are reluctant to complete reports for £90 let alone £10! Does seem harsh...
Posted by: James | Dec 02 2011
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