Pruhealth Comments from patients

We have been receiving increased comments from our patients who are insured with Pruhealth about Pruhealth’s provision of physiotherapy cover.

Complaints about Pruhealth Insurance

The main comments have that patients have told us are:

  • Pruhealth is making it more difficult to claim for physiotherapy
  • Pruhealth is trying to encourage patients to go to their own network of physios, rather than where the patient wants to go to, or where the GP has referred them
  • Pruhealth will only pay £35 per session of physiotherapy if referred by a GP

A quick and simple online search will reveal other customers complaints or comments.  These online forums must always be viewed skeptically in my mind.  You can view this online here.

Recently BOOST PHYSIO raised a complaint with Pruhealth about how they were authorising physiotherapy treatment for their patients.  Here is part of the response that we received.

“PruHealth works in partnership with both IPRS and Nuffield Healthcare regarding our physiotherapy claims. Our customer care teams assess the claim eligibility and refer physiotherapy claims through to IPRS. As part of the process flow IPRS will discuss the patients needs and establish whether the member has a physiotherapist they would like to use or if they need assistance in locating a physiotherapy. If the latter then the member is advised of the benefits of using a physio within the IPRS /Nuffield network (a primary benefit being that we allow members to make a self referral and thus remove the need to obtain a GP appointment/referral).

… If they opt to use a physiotherapist outside of the network, then they are entitled to do so and IPRS/Nuffield will authorise a fixed number of sessions. They will ask for an update report before confirming cover for any further sessions.

…Members who have purchased there (sic) policies within the past 15 months or so will be on the revised policy terms which supports our physiotherapy network approach. On these schemes we contribute £35 per sessions towards physiotherapy. A session is defined as 30 minutes.”

We would like to hear of your own personal experiences with Pruhealth, so please do email me your experiences to: steven@boostphysio.com

More recently I received the following email in response to the above mentioned complaints that we had been receiving from our patients about Pruhealth’s new physiotherapy authorisation scheme.  Below is the email that I received on 24 February 2013 from Jayne Evans at Pruhealth, whereby Jayne Evans makes some valid and interesting points.

Dear Mr Berkman

I have reviewed the recent exchange of comments in respect of PruHealths physiotherapy network, and would like to take the opportunity to further explain the rationale for the introduction of our Professional Physiotherapy Practice.

PruHealth is committed to ensuring that our customer have access to the broadest range of high quality cost effective healthcare providers. All of our customers are promised a full refund on their eligible claims.

The management of physiotherapy claims presents a number of challenges for us as an insurer. This benefit is a high volume area of claims, and we must obviously ensure that claims are settled promptly in accordance with policy terms. In the last few years we have seen an increasing level of over servicing of customers, however within the physiotherpay market there is no established independent peer review process. Although we have a number of clinicians in our business, we are not positioned to have a physiotherapist to physiotherapist discussion on the appropriateness of treatments, nor the review of treatment plans, even on those rare occasions when we are successful in obtaining full details of planned treatments and expected outcomes.

Whilst we fully understand that not all conditions can be fully treated within 4 – 6 session, the frequency with which treatments sessions extend beyond 6 sessions continuing for 20, 30, 60 + sessions is breath taking, and yet the customers condition not only remains unresolved, no alternative solution is provided to appropriately conclude the patients treatment and/or resolve their condition. The physiotherapists at IPRS & Nuffield are UK based chartered physiotherapists, and give PruHealth and our customer the independent clinical advice and support needed to ensure customers are offered the very best care to meet their treatment need.

Working with IPRS & Nuffield means that we ensure that not only are treatment discussions held between peers, but the focus of these discussions are on the appropriateness of treatment in meeting the patients needs, as well as meeting the terms of eligibility of the customers insurance policy. It is extremely important to us that these discussions are led by independent physiotherapists and set against a set of clinical protocols, and that treatment plans are individually tailored to meet the patients needs. There can be no one size fits all approach.

All members of their practices are required to meet a standard set of recognition and practice criteria, which IPRS and Nuffield set to ensure their clinical and quality standards are met. A physiotherapist can apply to join their membership, and their application will be considered against this standard recognition criteria.

The Professional Physiotherapy Service was introduced, to ensure that our customers have their treatment provided by independently accredited practitioners, working against a set of clinical protocols, and that treatment plans are independently panel of peers, all of which helps protect our full refund promise to our customers.

Turning to the specific relationship between your own practice and PruHealth, a review of claims indicates that many patients have had treatment extending beyond 6 sessions or more, whilst extended treatments  may well be appropriate, as an insurer, rather than a provider of healthcare we would previously had no way of assessing the appropriateness of the patients treatment. Now with our new process we are able to ensure that the treatments meet the customers needs, and that any challenge to treatment is led by independent chartered physiotherapists.

What Ms Evans has not explained in her email is why Pruhealth will not pay Physiotherapists outside of their preferred network at their full rates.

 

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BOOST PHYSIO works with major insurance companies like: BUPA, AVIVA, WPA, CIGNA and Simplyhealth. We usually deal directly with your insurance company.