The Association of Medical Insurance Intermediaries (AMII) wants the Office of Fair Trading (OFT) review of the private healthcare sector to produce greater clarity from medical insurers and practitioners.
The Association revealed it is considering a submission of its own to the OFT but is also encouraging any interested individual members to do so as well.
Although the OFT's review is primarily aimed at the private healthcare sector, its scope embraces the ‘critical input' of private medical insurance (PMI), including the relationship between PMI providers and healthcare providers.
Speaking to COVER, Michael Payne, general secretary of AMII, explained that some members have concerns about hospital networks created by PMI providers, particularly if this has not been clarified in policy documents or relates to a specific medical condition.
"Although part of it is around controlling costs, another argument that insurers use is they believe there's clinical evidence that its in the customers best interests to use this consultant for all this type of surgery because they practice it on a regular basis and so quality control is in place," he said.
"But from an intermediary's point of view we've not seen any evidence from insurers to back up that argument and that impacts on BUPA criticising the healthcare sector for not providing the same clinical evidence the NHS has to.
"So if insurers are making judgments in setting up these networks of consultants, what information are they making these judgments on? If it's around quality then it's not really that transparent what criteria are they using," he added.
Payne is also hopeful the review will increase transparency regarding consultant fee limits, something he believes is a necessity but could be better handled.
"Some organisations believe there shouldn't be any fee limits, but from a policyholder point of view there's got to be some control over claims costs and this is one element that could spiral out of control if it is removed by the insurers, however again it does need to be transparent," he continued.
"A good outcome would be a requirement for consultants to be up front about their fees before proceeding with treatment so policyholders, or members of the public buying treatment direct, know what the costs are going to be.
"That's one area that doesn't really happen at the moment. If patients know up front what they are going to be charged and what limits, if any, are in place from insurers, then they can make a more informed decision about continuing with that consultant for their treatment," he added.
