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NEWS | Wednesday, 06 August 2008

Bupa insurance ‘cut’ would be ‘theft’ - Frank Portelli

The director of St Philip’s Hospital, Dr Frank Portelli, did not mince his words about BUPA Malta’s decision not to honour in full claims for treatment in other private hospitals not included in the insurance company’s list of “participating hospitals”.
“If you have a full hospital insurance cover with BUPA and they only pay 80% of the claim for private hospital treatment, then BUPA would be stealing from you the remaining 20%,” Portelli told MaltaToday Midweek when asked to comment about BUPA’s recent decision.
On 21 July, BUPA Malta sent a letter to all subscribers announcing that it had reached an agreement with the St. James Group, which comprises Saint James Capua Hospital in Sliema, Saint James Hospital Zabbar and Saint James Clinic in Mosta.
In its letter, BUPA Malta stressed that “wherever possible, treatment should be received in a BUPA participating hospital”.
However, should subscribers choose to receive their treatment in a “non-participating hospital”, benefits for pre-authorised treatment would be paid at 80% of eligible costs.
Portelli’s Saint Philip Hospital is one of the major private hospitals in Malta which has not been included in BUPA’s “participating hospitals list”.
Moreover, direct settlement with a non-participating hospital would not be possible.
“St Philip’s Hospital is an independent hospital which is fully licenced by the Maltese health authorities and exceeds all the required standards. BUPA Malta is an Agency of BUPA UK as such it has no statutory role in setting standards nor to ‘approve’ hospitals or clinics either in Malta or in the UK,” Portelli said.
“The term approve may be misleading. BUPA Malta has approved ‘clinics’ whose standards I personally would not have approved – such as for instance the re-sterilizing of disposable instruments. Some instruments are designed to be used once and then to be thrown away after use – obviously this raises costs,” Portelli said.
Portelli went further to state the Office of Fair Trading and the Financial Services Authority should look into the matter.
St Edward’s clinic has also filed a judicial protest claiming BUPA was behaving in a way that did not allow a level playing field by informing clients to choose only those clinics or hospitals forming part of its approved list.
St Edward’s Clinic complained that it was suffering as a result of the agreement struck by BUPA with the private hospitals and clinics in order to feature on the approved list. The clinic called on BUPA to withdraw its directive to its clients.
Apart from the Saint James Group, the BUPA private hospital scheme currently includes Da Vinci Hospital in Birkirkara, St Mark’s Health Clinic in Msida, and Family Health Services in Rabat.
BUPA Malta said it hoped to conclude “similar agreements with other providers for the mutual benefit of our clients and private medical entities”.
However, until these agreements are signed, BUPA Malta said it would continue to settle similar claims on a “customary and reasonable basis, taking into consideration current market practices.”
Various e-mails with a number of questions sent to BUPA Malta’s Branch Manager Adriana Zarb Adami by e-mail were left unanswered.

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