Information for Doctors

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Ramsay Health Care and Bupa have not reached agreement on a new contract, resulting in the termination of the existing agreement.

This will unfortunately impact Bupa members wishing to access Ramsay Health Care facilities after 2 August 2022.  After this date, benefits paid by Bupa will reduce for policy-holders accessing treatment at Ramsay Health Care facilities, unless transitional arrangements apply.

Where transitional arrangements do not apply, Bupa policy-holders will be required to pay increased out-of-pocket costs for admission at Ramsay hospitals. Ramsay is unable to absorb these out-of-pocket costs.

Communication regarding the impacts on Bupa policy-holders is planned for the coming days and weeks, in accordance with the Ombudsman’s Termination and Transition Guidelines.  Communications regarding transitional arrangements is planned after 3 June 2022, once those communications have been agreed with Bupa.

This may also impact doctors participating in the BUPA Medical Gap Scheme. We recommend doctors review their entitlement to “In Hospital Medical Gap Scheme Benefits” and contact Bupa if they have questions.

We apologise for the significant inconvenience this may cause you, your staff and any of your patients insured with Bupa.

Why have Ramsay Health Care and Bupa not reached agreement?

Maintaining high quality levels of care for our patients is of utmost importance. Ramsay hospitals have played an important and active role Australia’s COVID-19 pandemic response, while also ensuring our patients and health care workers have remained safe with appropriate PPE, social distancing, cleaning and training.

Costs of providing care have significantly increased for private hospitals over the past two years. On the other hand, health insurers have accumulated profits of $1.8 billion in the calendar year to 31 December 2021.

Ramsay considers higher benefits are necessary to cover the cost increases private hospitals are now faced with, when providing quality care to patients.

What Next?

Ramsay will work with Bupa over the coming weeks to agree the communications to patients regarding:

  • Ramsay no longer having an agreement with Bupa;
  • Ramsay continuing to have agreements with all other Australian health insurers;
  • Bupa policy-holders paying an additional out-of-pocket cost; and
  • Bupa policy-holder options to minimise these additional out-of-pocket costs, including by discussing the timing of treatment with their doctor or reviewing their cover.

 

If you or your practice staff have any questions, please call or email our dedicated Contact Centre:

 

Questions about changing cover?

The law includes special ‘portability’ rules that mean consumers changing cover (or insurer) won’t have to re-serve the normal waiting periods again before benefits can be paid (they may have to serve waiting periods for any better benefits or conditions under the new cover). For further information, please access a copy of the Government brochure “Right to Change” or download it here.

 

Frequently Asked Questions

Ramsay Health Care has contracts with all other Australian private health insurers.

The amount patients need to pay will depend on their treatment, their level of cover and the amount of Bupa’s reduced benefits.  Once Bupa supplies Ramsay the non-contracted schedules of benefits we can inform policy-holders of their anticipated out-of-pocket costs.

The law includes special ‘portability’ rules that mean consumers changing cover (or insurer) won’t have to re-serve the normal waiting periods again before benefits can be paid (they may have to serve waiting periods for any better benefits or conditions under the new product). For further information, please access a copy of the Government brochure “Right to Change” or download it here.

Bupa are required, at law, to pay 25% of the Medicare Schedule Fee for hospital treatment at Ramsay hospitals (where the patient has the right level of cover and has fulfilled the relevant waiting periods and rules).

For Doctors participating in the BUPA Medical Gap Scheme, we recommend doctors review their entitlement to “In Hospital Medical Gap Scheme Benefits” and contact Bupa if they have questions.

With the benefit paid by Bupa reducing for policy-holders accessing treatment at Ramsay Health Care facilities after 2 August 2022 (unless transitional arrangements apply) Bupa policy-holders will be required to pay increased out-of-pocket costs for admission at Ramsay hospitals.

Once Bupa supplies Ramsay the non-agreement schedules of benefits, our admissions team will inform Bupa policy-holders of their anticipated out-of-pocket costs as part of the Informed Financial Consent process.

Ramsay is unable to absorb the out-of-pocket costs.

If a patient has financial difficulty paying the out-of-pocket costs, we strongly recommend they raise the issue with the Bupa customer service team.

Additional resources are available at www.protectyourcover.com.au or you and your practice staff can contact us with specific questions on:

• Email protectyourcover@ramsayhealth.com.au

• Phone Monday to Friday from 9am to 5pm on: 1800 MY HEALTH (1800 694 325)