Private medical insurers could be heading for a full scale conflict with medical practitioners as doctors' leaders are increasingly targeting providers' fee schedules.
The British Medical Association (BMA) has revealed it is urging the Office of Fair Trading (OFT) to have fee schedules investigated in its review of the private healthcare market.
Its move follows calls from other bodies representing medical staff for the practice of fixing payment levels to medical staff by insurers to be examined.
The BMA has said it will respond to an OFT consultation on the scope of the investigation by calling for insurers' fees to be examined.
It has already written to the Office asking it to investigate the fees that insurers insist consultants charge if they are to be ‘recognised' practitioners.
In a letter to OFT chief executive John Fingleton, Derek Machin, private practice committee chair at the BMA, raised concerns about the publication of the BUPA benefit maxima and the AXA PPP schedule of fees.
These, he said, gave details of the maximum fees newly recognised doctors can charge for certain procedures.
Machin countered that while it is important for patients to know how much they will be reimbursed by their insurers, the BUPA and AXA PPP documents have gained the status of guidelines, effectively telling private practitioners what to charge.
He added that the OFT must investigate whether they contravened a 1994 ruling by the former Monopolies and Mergers Commission that banned the BMA from publishing similar guidelines.
Machin concluded his letter saying: ‘These documents now exist to inform doctors what they will be paid for their services. These are not guidelines, but are fees that must be adhered to as a condition of recognition.'
The ABI has already welcomed the OFT's decision to review the sector, however the issue has been a long running one, with Bupa issuing a strong response to a previous discussion of the subject in Parliament.
