Bupa Ophthalmic Network

We’re committed to ensuring our customers receive high quality, good value healthcare. Our Ophthalmic Network agreements, which run until June 2028, will help us to do that.

Any Bupa recognised hospital or clinic providing cataract services can apply to join the network.

Yes, all hospitals/clinics in the network will need to have an up-to-date Bupa Core Quality Assessment valid within the last three years. To find out whether your hospital/clinic needs to complete one, please email us at [email protected]

The network runs for three years, and is due for renewal on 1st July 2028.

Once we’ve received your hospital/clinics application we’ll let you know if it meets the network criteria and is able to join. If your hospital/clinic doesn’t meet the criteria we’ll let you know why.

You can reapply to join the new network if your hospital or clinic’s circumstances change. If you’d like to resubmit an application or have any questions, please email us at [email protected]

A Standard Pathway agreement is where hospitals and consultants and anaesthetists all bill us separately for each individual element of cataract surgery.

A Full Pathway agreement is where hospitals manage the cataract surgery care pathway and all associated costs, including reimbursing consultants and anaesthetists, setting remuneration and delivering the pathway in line with the Royal College of Ophthalmologists’ guidelines and our network specifications. The hospital invoices us for a cataract surgery package.

Yes. While we hope hospitals will consider renewing their network agreement on a Full Pathway basis, we appreciate that this may not be an option for all consultants at the hospital, so you can renew your agreement on a Standard Pathway basis or have an agreement that combines both Standard and Full Pathway options.

If your hospital or clinic joins the network on a Full Pathway basis:

• It will reimburse ophthalmologists and anaesthetists who have agreed to accept patients for the Full Pathway and pay them for the care they provide
• Bupa will reimburse your hospital or clinic for the total cost of cataract surgery treatment in accordance with the terms of the Full Pathway agreement
• If an ophthalmologist or anaesthetist who is listed in your Full Pathway agreement invoices Bupa for any of the services included in the Full Pathway, we’ll need to recover the payment from them or your hospital or clinic (if the ophthalmologist or anaesthetist has not yet been paid by your hospital or clinic) as Bupa will have paid your hospital or clinic for it already.

We’ve looked at the Royal College of Ophthalmologists’ recommended pathway for high quality cataract services, reviewed self-pay rates and the NHS Tariff, and set fees for both the Full Pathway and Standard Pathway options that we believe enables hospitals and clinics to provide these services while keeping premiums affordable for our customers.

The hospital or clinic manages the cataract surgery care pathway and all associated costs, including:

• reimbursing ophthalmologists and anaesthetists
• setting remuneration
• delivering the pathway in line with the Royal College of Ophthalmologists’ guidelines and our network specifications

The hospital or clinic invoices Bupa for a cataract surgery package, which covers:

• all hospital or clinic fees
• the patient’s initial consultation
• pre-and post-operative tests (up to six weeks after surgery)
• cataract surgery
• anaesthetist’s fee (if appropriate)
• follow up consultation(s) with an ophthalmologist or optometrist

The Full Pathway fee is for a “Fixed Price Package” under our Business Rules (PDF, 1.3MB) - more details about what the fee includes is included in the Services and Charges Rules (paragraphs seven and eight).

No. By joining the network fees you’re agreeing to the fees until 1 July 2028.

If, after assessment, there’s a clear clinical rationale that indicates a Bupa patient is unsuitable for treatment on the Full Pathway, they can transfer to the Standard Pathway and continue treatment with the same ophthalmologist provided that the hospital or clinic also offers that pathway. If the hospital or clinic doesn’t offer that pathway, the ophthalmologist will need to see the patient at another network one that does.

Yes. Ophthalmologists, hospitals and clinics have told us that multifocal lens implants need more preoperative preparations and more intensive post-operative management than when mono-focal lenses are used.

As well as explaining to Bupa patients when they pre-authorise their treatment that they’ll be responsible for the additional charges if they choose a non-standard lens, we’ll also let them know that they need to pay any additional charges associated with the surgery, such as extra diagnostic tests and consultations.

Patients should only be asked to pay charges for tests and additional consultations that result from them choosing a non-standard lens and for hospital’s or clinic’s or ophthalmologist’s care that’s not included in the Full Pathway. Hospitals or clinics and ophthalmologists will need to itemise all additional charges and agree them in writing with the Bupa patient before surgery.

The patient will be responsible for settling these charges with the hospital or clinic and/or ophthalmologist, as they aren’t usually covered by our health insurance policies and schemes.

When a patient calls us to pre-authorise treatment, we’ll explain the treatment options available and let them know that all the costs of their care will be covered when they choose to have their surgery at a Full Pathway hospital/ clinic.

We’ll also encourage them to use Finder (finder.bupa.co.uk), our online directory of healthcare professionals and services, to look up any hospitals/ clinics they’re considering so they can make an informed choice about where to have their treatment.

8 out of 10 of Bupa patients choose to have their surgery at Full Pathway hospital or clinic, this offers them the reassurance of high quality care and the guarantee of an all-inclusive treatment package.

These hospitals and clinics are promoted with the Cataract Full Pathway badge on Finder, our online directory of healthcare services and professionals, which receives over 100,000 visits a week.

Yes, your hospital/clinic will still be able to treat Bupa cataract surgery patients; however, we’re unable to guarantee patient volumes. We know that 8 out of 10 customers prefer full pathway and this, together with the benefits we offer under the full pathway, may impact the number of Bupa patients your facility treats.