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OFT private healthcare study – AMII views

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The Association of Medical Insurance Intermediaries (AMII) has recognised that benefit fee limits and hospital networks are a necessity to maintaining a cost-effective insurance proposition for consumers in its initial submission to the Office of Fair Trading (OFT) on the proposed market study into private healthcare due for a formal launch in the spring.

However, AMII believes the OFT should make a clear distinction between those broad-based “hospital networks”, where the private medical insurance (PMI) policyholder has actively agreed to only obtain treatment at a selected list of hospitals in return for a lower premium; and the “treatment networks” where the insurer insists that for certain types of treatment (for example oral-surgery, ophthalmic conditions, certain types of cancer treatment) the PMI policyholder must use specific consultants/hospitals, which may be more restrictive than the general hospital list that the PMI policyholder has bought into.

In the latter case (“treatment networks”), the criteria that these insurers are using to determine which providers are included on the “treatment network” should be clear to private healthcare providers, medical professionals and consumers.

Source : AMII press Release