Page 93 - IDF Journal 2023

There are variations between providers
in the questions asked, some are not concerned with the number of claims you have had, some may only ask the history going back 3 years, and finally some do not ask if you have seen a specialist in the last 12 months.
Why Switch/CPME?
Switch/CPME is specific to those with existing cover, who are looking to save money or find better cover, with the potential to cover pre-existing conditions (subject to specific provider questions).
Claims
Claiming on your medical insurance should be swift and easy. Now, with many providers enabling you to obtain authorisation online, it can be simple. However, there are still guidelines to claims that need to be adhered to.
G.P. referral – authorisation from provider – specialist appointment – update provider on ongoing treatment
Most claims work, with well over 90% pay out rate for most providers. However, human error, mistakes on timelines, and use of incorrect terminology can all lead to claims being turned down.
It could be due to
• an employee unfamiliar with their type of underwriting
• a member may have switched from another provider and is entitled to treatment for pre-existing conditions
As a broker, we assist our clients at the point of claim. We want to ensure that you have a smooth pathway to better health.
How to reduce premiums
Recalling what a retired doctor once told me, “I never charged my colleagues and, once upon a time, we didn’t even charge the clergy”, how times have changed.
Legacy schemes can cost members up to 30-50% more than that of the newer style products. This is due to the schemes being closed to new joiners and consequentially, with a dwindling population, a high claims ratio, so that over a period of time the premiums increase.
Excess
Sometimes, simply adding a £100.00 excess can reduce premiums by 15%. Many medical professionals today have reduced out-patient benefits to keep costs down, the thinking being that “I’m happy to pay for the odd consultation or blood tests for a significant reduction of premium with the money better in my account than the providers.”
Directed pathways / guided options
Launched by BUPA many years ago, the consultant partnership was one of the first guided options designed to ensure the member did not receive a shortfall
in surgeon/anaesthetist fees. This was much to the medical professions dismay
at the time. However, today, most companies offer directed pathways also known as guided options. This is where the claiming member is provided a choice of at least 3 consultants locally in that field, and with access to several hospitals. To the lay person, this works well as
they just want to be treated promptly by
a doctor. It can also reduce premiums
for both individuals and companies of between 30% and 40%. This ensures doctors, nurses and hospitals have a good stream of work. However, choice
is still available to those who want to be able to choose their consultant at the point of claim - it simply costs more.
We advise medical professionals, individuals and corporate clients on all their medical protection requirements. Please take the time to look at our website for examples of how we have helped many of your colleagues.
Simon Cross
Managing Director
Access to Healthcare
62 South Street, Chichester, West Sussex PO19 1EE
T: 01243 783556
E: simonc@accesstohealthcare. co.uk
W: www.accesstohealthcare.co.uk
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