BUPA 'Approved Ophthalmic Units'
April 2007
BUPA will shortly continue with their plans to launch an “Approved Ophthalmic Unit” network from 16 April 2007. As we have indicated previously, feedback that we have received from regions suggests that a majority of Ophthalmologists do not wish to be involved in BUPA’s network.
You will recall that BUPA intends to segregate Ophthalmologists into “Approved” and “Recognised”. When challenged in the past by the Royal College of Ophthalmologists, BUPA indicated there was no difference in skill or competency within such segregation. It may be the case that BUPA segregates only in the level of re-imbursement they offer Ophthalmologists, through their policy holders.
Our concern is that policy holder’s reimbursement for phakoemulsification will be reduced by between 40 and 50 per cent for Recognised Consultants – the vast majority in the UK. For Approved Consultants there is no specified reimbursement level – unlike one hundred other listed procedures. We are concerned about whether BUPA may plan to leave this as a matter for local private provider units.
Although BUPA offers cover to its policy holders, as with other insurance companies, you and your patients should remain clear that any contract is between yourself and the patient for professional services rendered. Having made your fee levels clear, at the outset, it follows that accounts are to be submitted directly to the patient.
Many of you will have had discussions with your local private hospitals. The hospitals may be opposed to the BUPA network and thus, do not wish to be involved. In order to understand and explore the hospital’s position it might be useful for you to keep in regular contact with the hospital, but ultimately this is a decision for you to make. As we have noted before, BMI Healthcare Limited have confirmed they will not be involved in any team submissions for any network status. BUPA have offered no example of any large metropolitan Ophthalmic Unit taking up their offer.
These are changing times and as with other professions, Ophthalmologists may benefit from re-valuating the working relationship with their colleagues as, for example, have those in the Consultant Eye Surgeons Partnership (http://www.cesp.co.uk). The BMA’s OGC is looking to produce further guidance in this area.
Yours sincerely,
Derek Machin
Chairman, Private Practice Committee
Mr Rhod Daniel
Chairman, Ophthalmic Group Committee
Simon Longstaff
Deputy Chairman, Ophthalmic Group Committee