Chris Anderson Urological Surgeon
Mr Chris Anderson

Consultant Urological Surgeon
in London, UK

Referrals and Insurance Company Issues

Usually patients are referred by GP but self referrals will also be seen without problem. If patients are insured, the insurance company will be sent the invoice for the consultations and the patient will receive copies. If there is a shortfall, the patient is expected to pay this directly. If patients are not insured they need to pay for the consultation on the day by credit card, cash or guaranteed cheque. Embassy patients will be seen if the have letter of guarantee and the embassy billed directly.

I have a contract with some Private Medical Insurance companies (PMI), and where this contract exists there will be no shortfall in payment. It is essential that patients discuss this with my secretary so they know what to expect. In instances where I don’t have a fee assured contract with Insurers, or in the case of uninsured patients, Patients need to be aware that my contract for the whole fee for any surgery is with them directly. Certain major operations might be priced at higher rates than the insurer will reimburse but I charge smaller procedures at Insurance company rates. Therefore, for major operations there might be a shortfall. Please make sure this is discussed with me or my secretary before the surgery. For certain cases a deposit or the full amount might be requested prior to undertaking the surgery.

I am a member of the Independent Doctors Federation ( IDF) which is a body representing the interests of Doctors in Private Practice. There has been considerable discussion between the IDF and Private Medical Insurers ( PMI’s) to try and resolve disputes regarding fees and delisting of doctors .

PMI’s set their own schedule of reimbursements, which will not necessarily cover the full fees. This is based on historical figures which mostly haven’t changed since the mid nineties (despite PMI’s raising their subscriptions consistently ever since then!) Hence the reimbursements to surgeons are often considered to be too low and, in my case, unacceptably low for major renal and prostate cancer surgery.

There has been concern that some PMIs inform patients that a doctor has been “delisted”,or is not “recognised” or in some cases even “suspended” if they choose to charge more than the reimbursement fee. The PMIs have informed the IDF that the wording is very carefully scripted but despite this, patients can be left with the impression that the doctor’s quality of care is in some way substandard or that they have been delisted or struck-off by the GMC. However, in practice, they may simply have failed to agree to a reduction of fees agreed with that PMI many years ago. The IDF believes that this is anticompetitive behavior.

In recent years many operation reimbursements have even been diminished by PMI’s which has added to the difficulties!

The IDF strongly oppose “open referral” or other similar practices. Best practice requires patients to be referred by their general practitioner to a relevant specialist and that they provide all the necessary information regarding past history, medication etc. They do not agree with PMIs interfering with this pathway, especially without any reference to the referring doctor, which in some cases can result in the patient being referred to an inappropriate specialist who might not have the requisite skill for a particular procedure .The IDF has provided an initial submission to the Competition Commission’s investigation into private healthcare and a response to the recently published statement of issues. They continue to meet with medical directors and other representatives of some of the PMIs to discuss the situation.

As a general rule I try at all times to be transparent and will always be prepared to discuss the surgical fees prior to the event.