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OPEN REFERRAL
SCHEMES

Open referral uses your GPs diagnosis and Bupa's expertise to help you find the right consultant and facility for your clinical needs. If you need a specialist referral, we will help you choose a consultant, usually offering a choice of two or three for you to see.

Our promise

Our promise to members on our Open Referral scheme is that we will offer you a clinically appropriate consultant for your needs and that where you preauthorise following the Open Referral process, we guarantee the surgeon’s and anaesthetist’s fees for eligible surgical procedures will be covered.

Benefits of Open Referral

Informed choice

We aim to offer a choice of up to two or three consultants to meet your clinical needs. You can then review these on our Consultant and facilities finder. This means you can learn more about the consultants available to you and make an informed choice of which one you’d like to see.

  •  

JUST

7%^

of GPs saw their role as making a definite recommendation for a particular choice of facility and / or consultant.

Better value

For members who follow the Open Referral process we will ensure you are referred to a consultant who charges within Bupa’s benefit limits. This means that you will not receive any additional unexpected surgical or anaesthetists bills for eligible treatment. We also ensure that consultants we offer under Open Referral do not have an unusually high overall cost of care.

+15%~

greater satisfaction amongst those personal members who received help choosing their consultant than those who did not.

Quality and customer experience

Consultants we offer through Open Referral meet additional criteria in relation to how their clinical practice and customer experience compares to other consultants in their medical specialty. Examples of areas we review include:

  • How many procedures a consultant has performed
  • Likelihood of having surgery
  • Use of diagnostic tests
  • Complaints received
     

Why has Bupa introduced Open Referral?

Traditionally, a GP refers patients to a specific hospital or consultant. Research conducted for the Office of Fair Trading and the Competition Commission (now called the Competition and Markets Authority) review into private healthcare showed that GPs do not generally have access to objective data about the quality or cost of care of consultants’ practices and facilities. We help our customers make an informed choice about who to see by using the extensive information we have about Bupa recognised consultants, including how the treatment they provide compares to other similar consultants and the overall cost of the treatment and care they provide.

Just 7% of GPs saw their role as ‘making a definite recommendation for a particular choice of facility and/or consultant’ – Office of Fair Trading (OFT) Consultant and GP survey

Only around 12% of GPs strongly or slightly agreed that they take account of what a consultant charges when referring patients privately - Office of Fair Trading (OFT) Consultant and GP survey

Only 24% of GPs considered that they had access to objective information about consultants specialist practice and their clinical outcomes data – Kantar Health Survey December 2011/January 2012
 

Make an Open Referral claim

More information

Download an Open Referral form (PDF, 41kb) and letter for your GP (PDF, 186kb)

General Open Referral frequently asked questions

Read our frequently asked questions

* Calls may be recorded and may be monitored.
^ Office of Fair Trading (OFT) Consultant and GP Survey 2011.
~ Members Choices Customer Satisfaction, Ipsos Mori April 2012.

Bupa health insurance is provided by Bupa Insurance Limited. Registered in England and Wales No. 3956433. Bupa Insurance Services Limited. Registered in England and Wales No. 3829851. Bupa Insurance limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Bupa Insurance Services Limited is authorised and regulated by the Financial Conduct Authority. Registered office: Bupa House, 15-19 Bloomsbury Way, London WC1A 2BA.

To make a claim

Personal scheme members
0845 609 0111*
Lines are open 8am to 8pm Monday to Friday and 8am to 6pm on Saturday.

Business scheme members
0845 609 0444*
Lines are open 8am to 8pm Monday to Friday and 8am to 1pm on Saturday.

Useful documents

Download customer actions pdf Open Referral form
(PDF, 41kb)

Download customer actions pdf Open Referral
GP letter

(PDF, 186kb)