Consultants' fees explained
We’re committed to giving our customers access to high quality, affordable healthcare. They pay for doctors’ fees through their premiums and we work hard to make sure they pay a fair price. It’s also important that the fees we pay consultants appropriately to reflect procedure complexity, consultants’ skills and expertise and the costs incurred in running a private practice.
Here you’ll find out:
- What you can charge for
- How we set and agree our fees
- How we review procedures
What can consultants charge for
All our recognised consultants can charge for consultations and procedures for our customers as long as they’re published in our Schedule of Procedures, within the consultant’s respective specialty and covered by the customer’s policy or scheme.
Our policies and schemes cover the cost of medically necessary, planned private consultations, tests and treatment for acute conditions at Bupa recognised hospitals and clinics.
To be covered, treatments (together with the products and equipment used as part of the treatment) need to be:
- consistent with generally accepted standards of medical practice and representative of best practices in the medical profession in the UK
- clinically appropriate in terms of type, frequency, extent, duration and the facility or location where the services are provided
- demonstrated through scientific evidence to be effective in improving health outcomes
- not provided or used primarily for the expediency of the patient or their consultant or other healthcare professional
Consultants are responsible for making sure that all care is relevant and that they have the professional capability and training to deliver the care.
- We only reimburse consultants who are Bupa recognised for treating our customers.
- Surgeons, physicians and anaesthetists need to charge us in line with the billing rules found in the essential notes of our Schedule of Procedures
Our customers are responsible for making sure that the treatment, services or charges are covered by their policy or scheme.
It’s important that our customers call us to check that they’re covered before going ahead with any treatment because the policies and schemes that they, or their employers, choose can differ. There are varying levels of cover, for example, some include cancer cover or diagnostic tests, while others don’t, and outpatient allowances vary.
Out–patient diagnostic tests
- Some Bupa recognised consultants can also charge for other services, as long as they have a specific agreement with Bupa to do this. For example:
- diagnostic tests which are published in our Schedule of Diagnostic Tests and are performed by consultants using their own equipment in an outpatient clinic or consulting rooms. There’s more information about this in the Diagnostic and other fees section below [Link to ‘Diagnostic and other fees’].
- We’re only able to accept invoices for these services from consultants with the specific outpatient diagnostic tests agreement.
How we set and agree fees
We agree outpatient consultation fees with consultants in multiple specialties. These fees reflect the differing nature of the services they provide. For example, consultant psychiatrists deliver the majority of care during outpatient consultations whereas a surgeon delivers care in a range of settings, so we offer fees based on these differences.
Our customers expect us to manage fees on their behalf – in a survey we carried out in 2024, nine out of 10 people with health insurance said their health insurer should negotiate the best prices with consultants to manage costs on their behalf.
Many of them have outpatient benefit allowances, often around £1,000 a year, and when these are reached customers must pay for all consultation fees above their benefit allowances themselves. So they want us to minimise any additional costs or unexpected bills (shortfalls), and this remains central to the policies and schemes we offer them.
As a result, we may occasionally have to remove Bupa recognition if a consultant charges fees that are out of line with their peers with no justification.
Procedure feesWe list the complexity grade, and surgical and anaesthetic benefit limits for all procedures in our Schedule of Procedures. This is to ensure fair reimbursement for consultants and help to keep premium increases as low as possible for our customers. There’s more information below about how we set these fees.
Diagnostics are normally provided and billed for by hospitals and facilities, however consultants can provide these services as well. If you’d like to be reimbursed for providing these services to Bupa customers, you’ll need a separate agreement with us which sets out the services offered and the fees we’ve agreed for them. The fees for these services will be based on the fees charged by other providers offering the same service.
Our Schedule of Diagnostic Tests lists all the tests that you can invoice for, so long as you perform them yourself in your consulting room using equipment that you have purchased and maintained. They’re marked with “OPDT” under the procedure code. We can only reimburse consultants for these tests if they have an agreement with us for providing them.
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How we set procedure fees How we set procedure fees
To make sure our fees more appropriately reflect consultants’ skills and expertise, we commissioned Curzon Consulting, who are specialists in private healthcare provision and funding, to carry out an independent review.
Curzon Consulting's extensive review included speaking to consultants and some of their professional organisations, as well as collecting surgical data from various industry sources, such as private hospital groups..
They developed a model (PDF, 0.01MB) for us to use when calculating fees for clinical and anaesthetic procedures. As well as reflecting complexity, consultants’ skills and expertise, it also takes into account the costs incurred in running a private practice.
We continue to engage with consultants to refine and improve our methods for calculating procedure fees in future.
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What to do if you think the complexity grade of a procedure needs updating What to do if you think the complexity grade of a procedure needs updating
If you think the complexity grade of a procedure in our Schedule of Procedures should be reviewed, please write to us explaining the rationale for your view and include supporting clinical evidence. For example, how the particular procedure compares to other similarly classified ones in terms of complexity, time taken, and the level of skill required by the operator.
Where the evidence supports an update, one of our Medical Directors will consider it with input from independent practising clinicians in the relevant specialty who have no conflict of interest.
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What to do if you think a code needs changing or a new one should be added What to do if you think a code needs changing or a new one should be added
The Clinical Coding and Schedule Development Group (CCSD) sets the standard procedure and diagnostic test codes for the UK private healthcare sector. It welcomes requests to change codes or add new codes via the “Schedule amendments” section of its website because it helps to keep the codes up-to-date. CCSD discusses requests each month and once it has made a change, it’s up to each insurer to adopt it. We aim to adopt all changes within a month of CCSD’s decision.
Consultant recognition
Apply for recognition to help you build your private practice. You’ll be able to treat Bupa customers and we’ll reimburse you for your services.
