UK medical health insurance - Questions to ask your health insurer

If you should get cancer, what treatment will the insurer pay for?

Most consultants who have PMI choose BUPA. 1

If you should get cancer, what treatment will the medical health insurance pay for?

Even before you are diagnosed with cancer, BUPA can help you by enabling you to have speedy access to a consultant and the necessary tests, biopsies or scans you require for a quick diagnosis.2

 

If your consultant confirms that you have cancer, the treatment you need - surgery, radiotherapy, chemotherapy and related diagnostic tests - is also covered. As a BUPA member, you will have access to some of the most recently available cancer drugs, such as cituximab (colorectal cancer), glivec (chronic myeloid leukaemia) and zometa (used to treat those with secondary cancer in bones). The cost of such drugs can be significant; Glivec, for example, costs around £10,000 each year for each patient.

If you were to be diagnosed with breast or bowel cancer or needed a bone marrow or stem cell transplant, what would your insurer be able to tell you about appropriate places to be treated?

Since 1995 government bodies, such as the Department of Health and NICE, and professional organisations such as the Association of Breast Surgeons have used research to develop evidence based guidelines for the care of patients with certain cancers. The research has shown that patients with certain forms of cancer receive high quality diagnosis, treatment and care when they are treated by specialist teams of consultants, nurses and other clinicians with specialist skills. 3, 4, 5, 6, 7, 8, 9, 10

 

BUPA is the first UK insurer to establish national networks of approved hospitals for breast, and bowel cancers and specialist treatment centres for bone marrow and stem cell transplants. Each of the BUPA Approved Hospitals has completed a rigorous quality assessment giving us evidence that it can provide a level of clinical care in accordance with these evidence based guidelines, within high quality facilities.

 

We have worked closely with professional bodies such as the Association of Breast Surgeons and The British Society of Blood and Marrow Transplantation to develop rigorous assessment questionnaires for hospitals to complete and discussed the results of the assessments with these professional groups. We have also worked closely with the charity Beating Bowel Cancer to promote awareness of bowel cancer and of the BUPA Approved Bowel Cancer Hospitals.

 

To help you, as a BUPA member, choose where you would like your treatment you can find more details on our website or ask us about these approved hospitals.

Are the things that really matter to you covered by your medical health insurance?

Everyone's different and will have different medical needs throughout their lives. If you're younger, you could need painful wisdom teeth removed or physio for that troublesome knee that stops you playing football. If you're older, you might be concerned about cancer, heart disease, or a hip replacement. BUPA can offer cover for treatment of all these conditions.

Whilst we don't cover treatment that your GP can provide, you can be referred to a consultant endocrinologist (diabetologist) if your GP thinks you have developed diabetes or asthma.

BUPA Heartbeat can also provide cover for pre-existing conditions.

Does the insurer employ doctors and nurses who can provide help and advice?

BUPA HealthLine offers confidential and professional health information and support 24 hours a day, 365 days a year to members of BUPA Heartbeat and LocalCare Direct.

 

If you have any questions about your health you can call our members' HealthLine. It's staffed by fully qualified nurses who can help you with any health issues and questions. For example, you may want to ask about particular symptoms, side effects of surgery or drugs, or what jabs are needed for your holidays. It also offers you the opportunity to take part in our health management programs, such as stopping smoking and stress management. And of course it's all completely confidential.

How is customer satisfaction with medical health insurance monitored and measured and how satisfied are current customers?

At BUPA, we take all feedback from our customers very seriously and we pride ourselves on delivering high levels of customer service. Twice a year we ask an external agency to survey a sample of our members to find out how satisfied they are with all aspects of our service from joining, making a claim and renewing their membership. In our last survey, 81 percent of all our members rated our overall service as excellent or very good with 43 percent rating our service as excellent. In addition 72 percent of our members would recommend us to friends and family

Not all treatments require you to go into hospital, you may just need some physiotherapy. What does your insurer do to assess quality in this area?

BUPA has undertaken a programme of assessing the quality of physiotherapy practices throughout the UK. This is based not only on the qualifications and experience of the physiotherapist but also on the premises and customer service offered by that practice in order to recognise high quality physiotherapy service for the benefit of our members.

If you have private medical insurance, choice will be important to you. Research published in the British Medical Journal11 shows that patients feel more relaxed when chemotherapy is administered at home, offering greater flexibility and reassurance. Can your insurer offer you such choices?

BUPA is aware that people with cancer want to get on with living their lives and, for those members who want to have this flexibility we can cover, where it is medically appropriate, chemotherapy treatments in your own home. We selected a company to provide this service for our members from a number of such companies on the basis of a rigorous quality assessment of, amongst other things, their clinical quality, nursing team, training, and drug handling. Our aim is to ensure that if you choose to have your treatment at home that your experience of such treatment is sensitive to your needs, reassuring, flexible and efficient.

1) Silver Fern 2003

2) Please note that cover under the LocalCare Direct scheme is subject to the terms of the moratorium.

3) NHS Executive: Improving Outcomes in Colorectal Cancer The Manual and The Research Evidence 1997

4) ACPGBI: Guidelines for the Management of Colorectal Cancer 2001

5) NHS Executive: Improving Outcomes in Breast Cancer The Manual and the Research Evidence 1996 revised by NICE 2002

6) The BASO Breast Specialty Group: Guidelines for surgeons in the management of symptomatic breast disease in the United Kingdom (1998 revision)

7) EUSOMA: Requirements of a specialist breast unit European Journal of Cancer 2000: (36) 2288-2293

8) Department of Health: Manual of Cancer Services Standards 2004

9) Kingsmore D, Hole D & Gillis C: Why does Specialist Treatment of breast cancer improve survival? The role of surgical management British Journal of Cancer (2004) 1-6

10) Whittaker et al: Guidelines on the provision of facilities for the care of adult patients with haematological malignancies (including leukaemia and lymphoma and severe bone marrow failure) Clin Lab.Haem. 1995 (17) 3-10

11) BMJ 2001; 322:809-810 (7 April 2001): 'Home delivery: chemotherapy and pizza?'