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AMA Federal Council formally condemns Bupa move

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The AMA Federal Council has passed two motions against private health insurer Bupa over plans to change to its policies and coverage.

Meeting in Canberra on Friday March 16, the Federal Council held lengthy discussions about Bupa’s recent announcement to rework its medical gap scheme.

A third of Bupa’s Australian customers were told their cover for a range of procedures will change from a minimal benefit to total exclusion. 

And patients would only qualify for gap cover if treated in Bupa-approved facilities.

Bupa softened its position slightly after the AMA sharply condemned the announcement, but the AMA believes the move is still far too harsh and is heading towards a US-style managed care system.

It formally rebuked the private insurer with the following two motions: 

  1. “Federal Council expresses its concern at recent changes to health insurance products announced by Bupa.  These changes threaten member choice and access to health care.  Federal Council calls on Bupa to reconsider these changes and to act in the interests of its members and the broader Australian community.”
  2. “That Federal Council recommends that the AMA advises Australian citizens how they can change their private health insurance.”

The AMA has already forced an investigation into Bupa, after AMA President Dr Michael Gannon called on the Government to look into the legality of the private insurer’s move.

Federal Health Minster Greg Hunt subsequently ordered the Private Health Insurance Ombudsman to do exactly that.

The punitive changes were announced just weeks after Mr Hunt approved a 3.95 per cent increase to private health insurance premiums.

“The fact that the change has occurred straight after a premium increase, straight after agreement was made to retain second tier rates for non-contracted facilities, and straight after an announcement by Government to work collaboratively with the sector on the issue of out-of-pocket costs, is unconscionable,” Dr Gannon said.

“The AMA will not stand by and let Bupa, or any insurer, take this big leap towards US-style managed care.

“The care that Australian patients receive will not be dictated by a big multinational with a plan for vertical integration.”

The affected procedures include hip and knee replacements, IVF services, cataract and lens procedures, and renal dialysis.

Bupa made the announcement initially via letter to medical practices, suggesting to them that: “Prior to the commencement of any treatment, patients should be encouraged to contact Bupa directly to confirm their cover entitlements, and any possible out-of-pocket expenses that may be applicable.”

Bupa’s Head of Medical Benefits Andrew Ashcroft also wrote: “Customers affected by these changes will be given an opportunity to upgrade their cover should they wish to receive full coverage for services that were previously only restricted cover.”

Dr Gannon said customers were right to be concerned with the new list of exclusions, but that there was even more bad news hidden in the fine print of Bupa’s new business plan.

“From 1 August 2018, no-gap and known gap rates will now only be paid to the practitioner if the facility in which the procedure takes place also has an agreement with Bupa,” he said.

“Medical benefit rates outside those facilities will now only be paid at the minimum rate that the insurers are required to pay – that is, 25 per cent of the MBS.”

Dr Gannon has written to all AMA members to explain the changes and why they are bad for patients and the medical profession (the full letter can be viewed at ausmed/bupa-decision-bad-news-patients-and-profession).

CHRIS JOHNSON

 

PICTURE: AMA Federal Council passing motions condemning the Bupa changes.

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