BUPA's MRI network

BUPA's new network of MRI facilities came into effect on 20 April. It follows an extensive exercise to assess the price and quality of all providers. According to BUPA, the result will be that all members will have a high-quality, but reasonably priced, facility within easy reach.

As expected, all six of HCA's hospitals in Central London have been excluded. These are:

• Harley Street Clinic
• Lister Hospital
• London Bridge Hospital
• Princess Grace Hospital
• Portland Hospital
• Wellington Hospital

Unfortunately, BUPA is unable to give us a list of the other 150 or so facilities that it no longer wishes to do business with, but we believe that most are the less well used. One notable exception to this is St Anthony?s Hospital in Cheam, which has failed to gain selection despite having a generally very good reputation for high-quality healthcare.

What this network does not apply to is any scans that are performed while the member is an in-patient at a BUPA-recognised hospital. These will be fully covered at St Anthony's, the HCA units and any other facility excluded for out-patient scans.

BUPA members who do continue to use one of the excluded facilities as an out-patient will receive £100 of benefit towards the cost of their scan. As even a single-part scan normally costs over £400, anyone continuing to use the excluded facilities can expect a large bill. Even this small contribution will be denied to any member of BUPA's 'Select' product aimed at small businesses. As usual, all claimant communication and specific advice will be managed via the member helpline.

In principle, BUPA's initiative is good for the market. There are a lot of MRI units across the country of variable price and quality, and it makes sense to select the best while ensuring that there is good coverage everywhere. With this initiative, however, BUPA has gone much further than with previous provider networks that it has launched. Rather than present it as an option, normally with a reduced price, it seems that the new network will apply to all BUPA members across all products in all sectors with immediate effect.

Even if we accept that their selection process has been faultless - and many think that it has been deeply flawed - BUPA is not in a position to deny use of the selected facilities by its competitors. Many customers, individual and corporate, may want to retain maximum choice of providers and some will change insurer rather than be denied access to a local facility that they have come to trust.

The launch of the MRI list is the first of a number of networks that BUPA intend to develop in this manner, and there will be great interest to see how they operate in practice. BUPA has said, for instance, that it will take account of medical necessity in operating the MRI network and, consequently, if a scan can only be done at an excluded facility, BUPA will pay the full cost. On this basis, it has already given St Anthony's special dispensation to carry out cardiac scans on BUPA members.

But what about more marginal areas. Consultants will refer patients to a facility because they value the opinion of the particular radiologist (also a doctor of consultant grade) who supervises the unit and comments on the results of each scan. While this will often be simply a matter of familiarity, there are occasions where a radiologist has a special expertise that the referring consultant feels, rightly or wrongly, that they cannot get elsewhere in the locality. All communications from BUPA suggest that this scenario would not be viewed flexibly, but we have to wait and see.

What also needs clarification in practice is the application of BUPA's networks to large corporate plans. BUPA has always allowed considerable leeway to tailor these contracts to the client's wishes but its initial message has been that this will not be permitted with the new networks. However, it has now confirmed that health trusts will be permitted to retain fully paid access to all MRI facilities if they so wish. There must be some possibility that this will be extended to larger insured plans, if doing so affects BUPA's ability to win or retain an account.

Below is a link to the full list of BUPA's recognised MRI facilities.
A full list of all the MRI facilities included in the network can be found here.

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