Terms & Conditions for The Arm Clinic

This document of information and terms and conditions contains:

  • Information for private patients
  • Data Consent information
  • Medical Fees in the Private Sector Advice

(Federation of Independent Practitioner Organisations)

INFORMATION FOR PRIVATE PATIENTS

You have been referred to, or have asked to see a consultant at The Arm Clinic as a private patient. Please read all of the information on this sheet. If you decide that you do not wish to keep your appointment, then please contact us and let us know so that we can remove your name from our list and offer your appointment to another patient.

Details of the current charges for consultations, investigations and outpatient treatments can be found here: www.thearmclinic.com/fees/.

You may have x-rays and/or an MRI/CT scan at your consultation, or have a steroid, Ostenil and/or local anaesthetic injection; these will incur separate hospital charges. If you do not have private health insurance then the hospital fees may need to be paid at the time of your appointment. These charges may vary depending on the hospital so please check with the hospital direct for confirmation of these charges.

An invoice will be sent out following your consultation for the consultant’s fees. It is important that you confirm with your insurance company that they will pay for all of the relevant fees – any shortfalls or fees which are not settled in full are your responsibility.

Consultation Times:

An Initial Consultation will be scheduled for up to 30 minutes and a follow up appointment up to 15 minutes; however it may be that you appointment doesn’t last this long. Consultation fees are NOT charged on a pro rata basis unless your appointment overruns in which case you may be charged an additional fee.

Whilst we endeavour to run clinics to time, unfortunately there can be unexpected delays; however we will try to keep this to a minimum but we would appreciate your patience if delays do occur. Please be aware that the outpatient nurses are doing their best for all of the patients on a clinic so please treat them with the respect that they deserve.

During your examination, you may be required to remove your shirt/blouse; ladies are therefore asked to wear either a vest type top or sports bra underneath their clothing to avoid any unnecessary embarrassment.

Chaperones are available on request and we would encourage all patients to attend with a family member or friend. Please let us know in advance if you require a chaperone.

If at any time you are not happy with any aspect of your treatment or have any questions or concerns about your treatment then please do not hesitate to contact us on 01625 545 071 during office hours. 

Difficulties can arise when patients have misunderstood the exact nature of their entitlements under their medical insurance policy, or have not observed the terms of the policy (e.g. some policies only cover a consultation which has been arranged in response to a GP referral letter, and do not insure patients who are referred by another consultant or refer themselves). Because the ultimate responsibility for payment rests with the person who receives the service, it is absolutely essential that you check the conditions of any medical insurance policy you have — we cannot take on that responsibility. If you are uninsured, you are personally liable for all costs relating to your consultation and any surgery. Even if you are insured, you are personally liable for all costs that your insurers do not pay, up to and including the full amount charged, for all outpatient appointments, investigations and surgery fees including Anaesthetist and Hospital fees.

The charge for the consultations etc will be not less than as described on our fees page: www.thearmclinic.com/fees/. Please note that first appointments will be up to 30 minutes and follow up appointments will be up to 15 minutes. If your consultation overruns this time scale then there may be additional charges. You may also require an x-ray at the appointment, if you are unable to bring previous films with you or have not had any x-rays done previously. The charge for this varies, so please check with the hospital direct in advance. Please note that all charges are liable to change with little/no notice.

It is important to understand that your consultation will be an Orthopaedic consultation conducted in accordance with orthodox medical practice. Outcomes of consultations cannot be predicted in advance; therefore, there is no guarantee that the doctor will agree with previous medical opinions you have been given, or that he will agree with your own assessment of your symptoms, or that you will agree with his opinion (which may differ significantly from your prior expectations). None of these outcomes have any bearing on the cost of your consultation.

We ask you to agree to these terms by signing the declaration on the registration form.

  • If you do not have medical insurance, you must meet the cost of your consultation/surgery etc personally. You will be posted an invoice after your consultation which you agree to settle within 28 days of the date of invoice. Surgery fees may be required to be paid in advance.
  • If you have medical insurance, you must meet any costs which your insurer declines to pay, for whatever reason*, and you must send payment within 28 days of being asked to do so. This applies to fees for outpatient appointments, surgery and investigations. This also applies to any fees incurred, which are not outlined elsewhere on this document.

*for example, if your policy does not cover this consultation for any reason, or does not cover blood tests, or if there is an excess that you are expected to meet, or if there is a maximum amount that your insurer will pay for a consultation or towards surgical fees, or if you have exceeded the maximum amount payable from your policy in the current year, or if you fail to submit the required claim form(s) and / or invoice(s) to your insurer.

Please note that our consultants are not able to transfer patients from the private sector to NHS practice. If you require NHS treatment then your GP will need to send an NHS referral to the relevant consultant at Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, WN6 9EP

Please do not hesitate to contact us by telephone if there are any queries that you would like to discuss

The Wilmslow Hospital,
52 Alderley Road Wilmslow, SK9 1NY
Tel: +44 (0)1625 545 071
Fax: +44 (0)1204 525 521
www.thearmclinic.com

DATA CONSENT

We are proud to be at the forefront of research, education and excellence in clinical outcomes. As part of our commitment to these goals, we have for a long time collected selected patient data in the form of clinical photographs, operative pictures, technical details of the operations and outcome measures.

The purpose of collecting this information is patient education, research, training of doctors and professional colleagues (like nurses, physiotherapists and paramedics) via scientific journals, scientific presentations and web based resources. Collection of health outcome measures is aimed at scientifically assessing the outcomes of the interventions that you receive at this Service.

To reassure you regarding the judicious and appropriate use of such data and to comply with data protection regulations, we would request your permission for the following:

  1. I agree that my relevant personal details and relevant health information (details of intervention and outcome measures) related to this procedure will be held and used by our consultants and researchers on a secure database.
  2. I understand that the consultants and researchers will hold all information and data collected securely and in confidence and that all efforts will be made to ensure that I cannot be identified as a participant in the study (except as may be required by law) and I give permission to the researchers to hold relevant personal data.
  3. The data used for presentation, publication and/or teaching will be used in an anonymised and sensitive fashion.
  4. I understand the images requested are required for publication in a journal, textbook, as part of a display or information leaflet and that wherever possible identifying features will be excluded from the image. I understand that once images have been released for this purpose it may not be possible to control their future use and that withdrawal of consent may not be possible.

FIPO – Federation of Independent Practitioner Organisations

Medical Fees in the Private Sector – An Explanation for Patients 

What is the Federation of Independent Practitioner Organisations?

The Federation of Independent Practitioner Organisations (FIPO) is a non-profit making organisation whose membership includes all the professional groups representing consultants in the different specialities of medicine and surgery. It incorporates the major medical organisations in the UK independent acute healthcare sector including amongst many others the private practice committees of the British Medical Association, the Hospital Consultants and Specialists Association, the London Consultants’ Association, together with the Chairmen of a large number of Medical Advisory Committees from different private hospitals in the UK. The objectives of FIPO are to promote the highest possible standards of care in the private medical sector and to preserve the independence and freedom of choice for patient and doctor.

FIPO does not set or recommend medical fees nor does it encourage unreasonable or high charges. Any specific questions on fee levels should be directed to your consultant. FIPO does not accept membership from individual consultants and therefore cannot take responsibility for the actions of individual doctors. However, there are certain factors that govern your fee arrangements, which this document is intended to explain.

Medical Fees – Is there a contract between the patient and consultant?

Any patient who consults or is treated by a specialist (consultant) in the private medical sector will be personally responsible for the payment of all their specialist’s fees and a financial contract exists between them. In many instances patients have private medical insurance that will fully partially or reimburse them for their medical fees. However, there are often exclusions within these policies (i.e. specific medical conditions, outpatient allowances, or payment by the patients of an initial excess amount).

Sometimes there may be shortfalls in the reimbursement that the patient receives for the consultant’s fees. In the event that this occurs it must be borne by the patient who is personably liable to the consultant for his/her fees.

How do I get to see a consultant and do I need pre-authorisation by my insurance company?

Most patients are referred to a consultant on the recommendation of their General Practitioner (GP). This is the traditional route. Your GP will know the specialist interests and abilities of all the consultants to whom he/she refers patients. Some patients will have knowledge of a particular consultant and are fully entitled to ask to see that specialist. A referral letter from your GP is usual. It is at this stage that many insurance companies ask patients to contact them for pre-authorisation. Patients should always insist on seeing the consultant of their choice.

At pre-authorisation the patient may be given a specific claims number for this clinical event which it is advisable to use in correspondence with the insurance company. Occasionally at this stage the insurance company raises queries about the expected level of fees. In such circumstances the patient should always contact the consultant recommended by their GP to clarify the issue. This recommendation and referral was made by the GP on the basis of his/her best clinical judgement of the patient’s background and medical problem and was not influenced by any financial motives. Many consultants resist entering in to direct arrangements with certain insurance companies, as they are concerned that this will eventually affect their independence, choice of appropriate facility for their patients and will not be in the best long term clinical interests of their patients.

Can I get a fee estimates before treatment?

It is perfectly reasonable and acceptable to ask your consultant for an estimate of your fees prior to treatment. This can often be furnished for a standard operation (i.e. cataract extraction, hernia repair, hip replacement, hysterectomy etc.). The consultant should also do his/her best to tell you about other potential professional charges, such as the likely anaesthetist’s fee. It is possible that you will also have professional care from “back room” consultants (radiologists – x-ray doctors – or pathologists) who are entitled to submit accounts for their services. Your consultant may not be able to give you an exact quote but should be able to assist you in obtaining some information on what these are likely to be.

In some instances however, a fee estimate is impossible to calculate because your diagnosis and treatment is unclear. When complex or in the event of complications other specialists may be called to see you and your primary consultant will choose these doctors with your agreement. Sometimes, in a clinical emergency speed and expedience are critical and neither you nor your relatives may be able to exercise influence over these decisions. In these circumstances, patients should realise that doctors work in regular teams and that this reflects best clinical practice.

Your hospital charges are normally fully covered by your insurance company, who will have negotiated these set prices. However, there may be some restrictions, i.e. cover for a single as opposed to a double room, which are matters for you to resolve with the insurer and the hospital. You may also be charged for certain personal activities such as phone calls.

If your insurer asks for a Claims Form to be completed then either your consultant or GP will do this. It is important that all parts are filled in accurately. You are advised to keep a photocopy of all such forms.

Who pays the consultant’s fees?

Your consultant(s) will submit their fees for their services to you (and sometimes directly to your insurer by post or electronically). These fees should be laid out so as to illustrate clearly the services rendered. Normally, an operative fee will include routine post-operative care in the hospital. Separate fees are charged for follow-up consultations after surgery. PPP may now refuse to pay for follow up consultations if these take place within 10 days after discharge from hospital although other insurers will usually cover this charge.

You should note that whilst the insurance companies often settle professional bills directly, they do not pay consultant fees; they reimburse patients for consultant fees. The levels of reimbursements vary between different companies for the same procedure and consultants are not bound by any of these levels. If there are shortfalls then the patient is responsible for this amount, which should be paid directly to the consultant within a reasonable time. In some circumstances the consultant may be able to explain the particular complexity of the procedure to the insurance company and so enable the patient to receive a higher level of reimbursement.

Why are there fee shortfalls?

Some patients’ question why they may have to pay shortfalls and this is really based on the economics of private practice. The average patient’s insurance premiums have risen by at least 7% per annum for the last 10 years. Hospital prices have risen in line with this, but there has been no similar general movement to assist patients for their consultant fees. During this same period the actual reimbursement for consultant fees by the major insurers has not altered significantly and indeed some insurers may actually be reducing their allowances. Moreover, the costs of running a medical practice have risen dramatically, and these costs are particularly high in London and certain other parts of the country. Unfortunately the insurers give no extra weighting based on these geographical differences. These economic facts mean that more and more patients are facing shortfalls for consultant fees.

Most insurers will publish their actual reimbursements for various operations or treatments either in hard copy or on the internet. However, you should note if you are insured by PPP, that this company will not actually state the precise fee reimbursement for any given procedure but will only pay what it considers “usual and customary”. This can sometimes create difficulties for consultants and patients, as there is no published list of benefits payable.

Some Common Patient Questions

Why doesn’t my insurer settle all my accounts in full?

The answer lies in your insurance contract, which limits benefits.

Are there are any national guidelines or set tariffs for consultant charges?

The original guidelines on medical fees published by the British Medical Association were ruled illegal by the Monopolies and Mergers Commission in 1994. Since that time there has been no “official” or other tariff of fees. Furthermore, the Competition Act means that any group of doctors who publish such a list would be in breach of the Act.

What does “fixed price” or “package” surgery actually involve?

The terms and conditions of these so called “package prices” do vary. In some instances the consultant’s fees are included in the price; sometimes they are separate. Patients should always ask what the advantages and disadvantages are for these deals, in particular whether the hospital and consultants will include the costs of any complications and delayed discharges from hospital in the fixed price.

What happens if a complication occurs that necessitates a further operation or intensive care?

The hospital costs and extra consultant fees would need to be settled either by you if you are not insured or by your insurance company. Companies often question such bills and some demonstrate a reluctance to pay.

What is the meaning of an acute or chronic condition?

Some conditions may be defined as chronic by the insurers and may not be covered. However some of these conditions may have acute exacerbations and your consultant may be able to assist you in gaining reimbursement from your insurer although this cannot always be guaranteed.

This information sheet is issued by the Federation of Independent Practitioner Organisations (FIPO).

Further information can be found on www.fipo.org. (July 2003)