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Reasonable and Customary charges for Private Medical Insurance

Virtually all Private Medical Insurance companies use a system called reasonable and customary when it comes to prices charged by consultants and other specialists. Many private medical insurance customers are not aware of this and may not be told about this until they are making a claim or even not brought to their attention until they receive the bill in the post for the shortfall.

There has been a lot of talk about this recently in the private medical insurance market and many have called for a review of the system and the monetary limits. This amongst other issues has lead to the Office of Fair Trading to announce a full review of the private medical insurance market in December. The review will take place in Spring 2011 and aims to look at the not just consultant fees but the whole market place. The OFT website stated on the 14th December that the areas of concern are:

  • The level of concentration amongst providers of private healthcare at the national, regional and local levels, and whether this limits the extent of competition in the market.
  • The existence of any barriers preventing private healthcare providers from entering or expanding in the market.
  • The existence of any restrictions on the ability of consultants and other medical professionals to practice.
  • How consumers access and assess information, and how they exercise choice in the provision of private healthcare.

Charges for consultants and what the various agreements vary enormously and some providers such as Pru Health for new business from 1st March have guaranteed that they will not short fall any of their customers. Whereas other providers such as AXA PPP will stick by their limits as a way to control claims and costs which can be passed onto the customer.

The team at Health Matters deal with these issues everyday so if you are looking for impartial advice on how each provider operates then please contact us on 0800 988 0085.



James Henson 25-01-11

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