Our role as your insurer is to indemnify you against medical costs, incurred in your treatment, according to the contract that prevails between us.
In turn, when you receive treatment, a contract exists between you and the provider, be that a Private Hospital or a Consultant.
We have cost agreements with almost every hospital, and we publish our schedule of the fees which we reimburse Consultants - these may be viewed at any time.
Fee reimbursement levels are set at Customary and Reasonable levels by means of our continuing dialogue with the medical profession - for the vast majority of our customers this results in professional fees being reimbursed in full. Very occasionally there may be a shortfall and we are usually able to alert customers in advance of the treatment.
If your consultant charges more than we consider customary and reasonable, they have advised you of their fee before the treatment takes place, and you decide to proceed with the treatment, then it is your responsibility to settle the difference.
However, it has come to the attention of the Office of Fair Trading, the Financial Services Authority and the Competition Commission that some customers with Private Medical Insurance (PMI) are being faced with significant shortfalls when presented with the fees of their anaesthetist.
Consultants in private practice are required by the General Medical Council to give their patients, in writing, information about their fees prior to treatment taking place. However, many patients only meet their anaesthetist immediately prior to surgery without this fee information being provided.
In addition there is a voluntary code of practice for billing private patients produced by the Association of Anaesthetists of Great Britain and Ireland (AAGBI). This can be found at http://www.aagbi.org/sites/default/files/code_of_practice_08.pdf.
This guidance requires anaesthetists to be clear and transparent as to their fees prior to treatment and also states that if an anaesthetist does not warn the patient of the fee in advance, "he should not demand that the patient pay any shortfall if the PMI benefit is less than the fee charged".
Should you experience difficulties of this kind please let us know forthwith and we will do our utmost to assist you in the resolution of any matter that arises.