Bupa and surgeons are at loggerheads again after two medical bodies renewed their attack on the provider's decision to review patients referred for knee surgery and advised their fellows to not take part in the process.
The representative organisations believe Bupa's policyholders should be informed about the system and argued that it may mean they do not receive the surgery recommended to them.
But Bupa has hit back, charging the bodies with making misleading statements about the initiative and defending the need it.
The insurer said the process is designed to ensure that only appropriate treatment in line with evidence-based best practice is funded.
As COVER previously reported, the insurer introduced the reviews prior to approving funding after noting that the rate of arthroscopic knee surgery in its members in England is almost three times that of NHS patients.
However, in a wide ranging and scathing three page open letter to their members, the British Orthopaedic Association (BOA) and British Association for Surgery of the Knee (BASK) claim Bupa has done nothing to prove the need for this intervention and is in effect discrediting the vast majority of the profession.
The letter signed by Peter Kay, president of the BOA, and Tim Wilton, president of BASK, said that to their knowledge, Bupa had not informed surgeons identified as having significantly higher referral rates or reported any of those concerns (of alleged inappropriate practice) to the General Medical Council (GMC) or hospital medical directors.
"Our offer of support for a professionally-led audit to investigate the issues that Bupa has raised is yet to be taken up, but Bupa has now introduced the new scheme despite our misgivings.
"It seems to us that BUPA is casting doubt over the integrity and professionalism of the vast majority of orthopaedic surgeons who are, in fact, practising appropriately," they added.
The organisations were concerned that the removal of funding would inevitably result in delays or possibly the cancellation of treatment altogether, which could have ‘significant clinical consequences'.
The letter argued that "the use of an additional form (perhaps completed on a different day) containing a limited review of the history, is unlikely to provide a full and accurate reflection of the details of the case or consultation in most cases," and so instead advised the private medical insurance (PMI) provider to apply for the full cases notes.
It concluded by questioning the selection of other surgeons by Bupa to assess patients for surgery and demanded that if Bupa should inform their current and prospective policy holders.
"This will be important to ensure that Bupa's subscribers understand the limitations of their cover, rather than create confusion and uncertainty in the interaction between a Bupa-insured patient and their chosen specialist," it added.
However, Dr Annabel Bentley, medical director of Bupa Health and Wellbeing, reiterated the reasons for the scheme's introduction and criticised the statement.
"We are disappointed that the BOA, BASK and Federation of Independent Practitioner Organisations (FIPO) are providing misleading statements to their members about Bupa's initiative, which is designed to ensure that Bupa only funds appropriate treatment in line with evidence-based best practice," she said.
"The vast majority of consultants are completing this process and in the few cases where a consultant is unwilling to complete and sign the form - which takes less than five minutes - we are offering alternative knee consultants for the member to see and in almost all cases patients are switching to these alternative consultants.
"Every year, around 19,000 Bupa insured customers have a knee arthroscopy. We have reviewed the rate of knee arthroscopy amongst our insured customers and found that it is extremely high and we have been compelled to act to ensure that our members are not exposed unnecessarily to the risks of surgery," she added.
