This guidance is provided primarily for providers but is made available to members in the interests of transparency and treating customers fairly.
We recognise the importance of freedom of choice for patients to see the provider of their choice. We passionately believe access to providers should be a clinical choice, not a commercial decision driven by a health insurer.
When a patient receives private medical treatment, a contract is formed between them as the patient and their treatment provider, be that their specialist, therapist or hospital. A contract does not exist between us and the provider, although we will only reimburse fees to providers that we recognise.
We reimburse fees to a level we consider to be the customary and reasonable cost, within the terms and conditions of our customers’ policies and in accordance with our WPA Fee Schedule. It is a condition of provider recognition by WPA that patients are provided with written details of fees in advance of treatment taking place. In the event that a patient is not reasonably advised of fees and there is a shortfall against our WPA Fee Schedule which they have not agreed, we will support the patient in resisting demands for additional payment.
All treatment authorisation is made in good faith and is subject to any subsequent information received. In the event it transpires for any reason that payment has been made in error, we reserve the right to withdraw the patient’s cover and recover any provider payments made.
In all circumstances, we reserve the right at any time, in our sole discretion to withdraw or amend our recognition of a provider for whatever reason we deem appropriate.
This information also applies to WPA Protocol Plc, a wholly owned subsidiary and Appointed Representative of WPA.