The Office of Fair Trading (OFT) is making “informal enquiries” into complaints made against- several PMI providers’ practices.
These include BUPA’s consultant partnership scheme, which means enrolled consultants receive a bonus if they charge according to BUPA’s fees scale. It is understood a number of doctors are unhappy about this practice.
BUPA’s benefit maxima is also being looked at by the OFT. This is index of maximum prices paid for particular operations. If a consultant charges are above specified rate, the patient may not be sufficiently covered.
In addition, according to a spokesman from the OFT, a number of allegations about the PMI market generally are “under consideration”.
These include BUPA and PPP’s use of network hospitals, particularly how they affect the market in terms of anti-competitive behaviour or abuse of market power.
The enquiries follow complaints from small, often charity-run hospitals, who claim that their share of the market is threatened by reduced premium incentives offered by the larger insurers.
By paying smaller premiums, policyholders are offered reduced hospital lists, usually restricted to network hospitals.
However, many intermediaries, consultants and hospitals claim that this not only endangers the welfare of the hospital but also restricts the policyholder’s choice in determining consultant and type of care.
“BUPA and PPP hand pick the hospitals they include in their networks,” said Brian Clarke of the Charitable Hospital Foundation. “And if you are not with BUPA or PPP you will the going extremely hard.”
The Competition Act of 1980 was established to promote both productivity and improved levels of service and quality. Under the Competition Act, anti-competitive practice “has, is intended to have or is likely to have the effect of restricting distorting or preventing competition.”
In a statement, the OFT said: “We are interested in both the competition and consumer aspects of private medical insurance. We have not launched an inquiry as such, but we have had a number of complaints.”
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