AXA PPP not paying a consultant's fees in full
Discussion
My mother was diagnosed with lung cancer about three years ago, and is being treated privately as a private outpatient at a BMI Healthcare hospital in the UK. She has AXA PPP private healthcare cover, as do I.
Her cancer treatment consists of an Immunotherapy session every three weeks, preceded by a blood test a couple of days before each treatment. In addition, she is sent for a CT scan 3-4 times a year, after which she sees her oncologist a week later for no more than 10-15 minutes to discuss the results and decide on an action plan.
At my mother's advanced age, we are not expecting to be able to cure the lung cancer. Having said that the scans show that the spots of cancer in her lungs are reducing in size, although new spots have appeared. It seems to me that her biggest problem by far is not the lung cancer itself, but COPD which renders her unable to walk more than a few steps at a time without becoming breathless.
All of this is just background information. I have received a copy of an invoice to PPP by her oncologist for £450 in respect of our last 10-minute meeting. It seems that PPP have only paid £350 and he wants us to pay the outstanding amount of £100. While this doesn't seem like a huge amount, it happens every time he submits a bill to PPP and apparently mum just sends off a cheque. But is this correct? Surely PPP should cover his fees if they are reasonable. He has described the excess on his invoice as the "outstanding excess", presumably to make it seem that she has to pay it. But as far as I understand it, she should be paying her policy excess once per year to AXA PPP and that consultants should not be charging an excess every time they invoice her insurance.
So my question is whether it is usual and correct for this to happen. While I also have AXA PPP cover, I have never made a claim on it as I am generally in good health.
Thanks for any wisdom!
Her cancer treatment consists of an Immunotherapy session every three weeks, preceded by a blood test a couple of days before each treatment. In addition, she is sent for a CT scan 3-4 times a year, after which she sees her oncologist a week later for no more than 10-15 minutes to discuss the results and decide on an action plan.
At my mother's advanced age, we are not expecting to be able to cure the lung cancer. Having said that the scans show that the spots of cancer in her lungs are reducing in size, although new spots have appeared. It seems to me that her biggest problem by far is not the lung cancer itself, but COPD which renders her unable to walk more than a few steps at a time without becoming breathless.
All of this is just background information. I have received a copy of an invoice to PPP by her oncologist for £450 in respect of our last 10-minute meeting. It seems that PPP have only paid £350 and he wants us to pay the outstanding amount of £100. While this doesn't seem like a huge amount, it happens every time he submits a bill to PPP and apparently mum just sends off a cheque. But is this correct? Surely PPP should cover his fees if they are reasonable. He has described the excess on his invoice as the "outstanding excess", presumably to make it seem that she has to pay it. But as far as I understand it, she should be paying her policy excess once per year to AXA PPP and that consultants should not be charging an excess every time they invoice her insurance.
So my question is whether it is usual and correct for this to happen. While I also have AXA PPP cover, I have never made a claim on it as I am generally in good health.
Thanks for any wisdom!
It’s pretty common, particularly in more affluent areas
I don’t see the issue If the doctor has advertised their fees upfront. If AXA has a payment limit on the policy for a specific procedure etc then the patient will be liable for the shortfall. The problem there is with the insurers idea of acceptable fees.
Doctors will state that their contract is with the patient.
OTOH if the doctor had been approached via the insurer and has the more recent (cartel esque) ‘fee assured’ status, then I would contact the doctor and ask why they are charging beyond what had been anticipated and why. Also that you’d want a breakdown of any future excesses unless you change doctor
I don’t see the issue If the doctor has advertised their fees upfront. If AXA has a payment limit on the policy for a specific procedure etc then the patient will be liable for the shortfall. The problem there is with the insurers idea of acceptable fees.
Doctors will state that their contract is with the patient.
OTOH if the doctor had been approached via the insurer and has the more recent (cartel esque) ‘fee assured’ status, then I would contact the doctor and ask why they are charging beyond what had been anticipated and why. Also that you’d want a breakdown of any future excesses unless you change doctor
Thanks all. I haven't asked PPP because they pay the cost of the immunotherapy and the CT scans without question. So I thought it odd that they would not pay the consultant's fees in full. I don't have access to her policy easily to check but I imagine you're right. Do you think it would be out of order to ask the consultant to lower his fees to £350 for a consultation? I mean £2100 per hour is still very good money. But I know he has to pay the hospital for use of the facilities out of that. But probably so do all private consultants who charge less. My mother has no pension and no income and is living on her savings, so I would say that paying a consultant on a regular basis on top of her PPP premiums is something we should try to avoid.
Maybe Oncologists charge more but £450 seems immense. I had a whole series of consultations with spinal and neck/shoulder consultants in the NW and their ongoing fees were £150 per session.
The wife of a colleague (in the SE) has had quite long-term and intensive cancer treatment and that's all been covered by AXA - he thinks they're brilliant. I have no idea of the cost but it must be absolutely enormous.
The wife of a colleague (in the SE) has had quite long-term and intensive cancer treatment and that's all been covered by AXA - he thinks they're brilliant. I have no idea of the cost but it must be absolutely enormous.
Edited by Sheepshanks on Tuesday 6th October 21:43
AXA will only be paying up to their recommended fees, As the consultant was specified through them then he should be adhering to these fees for treatment and not charge over them.
Cancer cover is pretty comprehensive nowadays as an addition to the other benefits of a policy and has its own benefits and limits outside of usual outpatient limits etc.
Apart from an excess if you have one (this should only apply once a year on the first claim normally), you shouldn't have to pay anything extra.
I'd ring AXA and ask them why you are getting charged extra from the consultant and why are you having to pay it asap.
Edited to say, don't be afraid to query it with AXA, they will still pay for any eligible treatment no questions in full that's why you pay your premiums, don't bother querying it with the consultant, speak to your insurer first and see what they say.
You'd be surprised at the amount of consultant/specialists that try and pull a fast one.
Cancer cover is pretty comprehensive nowadays as an addition to the other benefits of a policy and has its own benefits and limits outside of usual outpatient limits etc.
Apart from an excess if you have one (this should only apply once a year on the first claim normally), you shouldn't have to pay anything extra.
I'd ring AXA and ask them why you are getting charged extra from the consultant and why are you having to pay it asap.
Edited to say, don't be afraid to query it with AXA, they will still pay for any eligible treatment no questions in full that's why you pay your premiums, don't bother querying it with the consultant, speak to your insurer first and see what they say.
You'd be surprised at the amount of consultant/specialists that try and pull a fast one.
Edited by Radec on Tuesday 6th October 21:54
AXA will request to speak to his mother first for authorisation to speak to him. They will have to go through security checks on the phone.
Although normally it is a one excess payment per contract year, this contract might be different so you would have to refer to the terms. For example, it could be lower monthly premiums if you are willing to pay the first 100 pound on each consultant visit.
Having said that, 450 does sound steep for a 15 minute consultation. I would have thought more like 100 to 150.
Although normally it is a one excess payment per contract year, this contract might be different so you would have to refer to the terms. For example, it could be lower monthly premiums if you are willing to pay the first 100 pound on each consultant visit.
Having said that, 450 does sound steep for a 15 minute consultation. I would have thought more like 100 to 150.
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