Consultant Fees and PHI Schemes
Benefits are what insurance companies pay out on behalf of patients according to the terms of their policy contract with them. Fees are what consultants charge patients for their professional services, except when they treat patients linked with insurers.
Consultant Fees
Consultants are free to set their own charges for private medical procedures but are prohibited from discussing fee rates with their colleagues – unless they are in a legally binding partnership or a limited company – due to restraints under competition law. For this reason, both the BAD and the BMA are unable to recommend fee rates for private medical practice.
Dermatology doctors may wish to use NHS tariffs for new and follow up appointments and procedures as a guide to informing their fees. This would align to the costs charged by NHS Hospitals seeing private patients. Additional test such as pathology should be added and incorporated in the consultation fee
Recognition with private medical insurers
Many individuals who receive private treatment do so as a result of private health insurance schemes (or benefits). PMIs (private medical insurers) – such as BUPA, AXA PPP, WPA and Aviva – will only reimburse patients for their specialist’s fees if the consultant has been granted specialist recognition with the insurer.
Changes to terms of recognition – as in the case of AXA PPP healthcare and BUPA – can cause issues for consultants and private practices, so it’s important that you are aware of these changes before accepting the criteria.
Signing up to the new terms is a commercial matter between the consultant and the PMI.
A membership organisation such as the BAD or the BMA are unable to set private practice fees for consultants and PMIs as this would attract unwelcome interest from the Competition and Markets Authority (CMA). We do however, work with PMIs on ensuring quality standards for our patient care pathways.
