Appalled by my latest experience with BUPA. I have been a member for 50+ years, but could no longer recommend the company to anyone considering joining. BUPA has decided that it can decide who should treat me, and who should be my consultant, physician or surgeon, regardless of my history, previous treatment, GP referral etc. etc. BUPA's latest wheeze has been to refuse to fee assure my eye consultant - I have been his patient for eight years but have cost BUPA very little, three consultations during that time I believe - who I wished to perform my cataract surgery. No, BUPA said, he charges far too much for this simple op, use someone we choose or you could go to an optician's in your local shopping centre..... BUPA are paying approximately 25% towards my surgery. I had just want to be treated by the consultant who knows me and my eye, and who has looked after me brilliantly since 2005.

Insurance fraud is a globally recognised problem. BUPA examples of common health insurance abuse and fraud including their regulations are solely displayed on the BUPA ARABIA website see below. Perhaps Bupa Customer Services can explain to BUPA members worldwide why their headings,“When to report a health insurance abuse and fraud?” “How to avoid and prevent health insurance abuse and fraud?” are not equally displayed on all their global websites, but only on the BUPA ARABIA site Perhaps Bupa could further inform policyholders what active measures they take to combat this phenomenon and how much fraud costs their organisation and members annually. It is obvious that the display of these regulations serves as a timely reminder to all parties when treatment is being undertaken for which there might be a BUPA claim. Indeed it is a reminder that everything must be carried out in a legitimate and transparent way. Certainly if Bupa had prominently displayed these regulations at the time of my treatment in the UK, much, if not all of the subsequent unpleasantness, expense and copious correspondence could, in my opinion, have effectively been avoided. Full story to follow.…..watch out for key words and phrases …….. overpayment, gratuity, pleading poverty, hearsay, nothing improper occurred, doctor’s words, it was reasonable to assume, FOS, GMC. WHEN TO REPORT A HEALTH INSURANCE ABUSE AND FRAUD? Examples of common health insurance abuse and fraud: • Billing for services not actually performed for the patient • Falsifying a patient's diagnosis to justify tests, surgeries or other procedures that are not medically necessary • Misrepresenting procedures performed to obtain payment for non-covered services, such as cosmetic surgery • Issue bills for more costly medical services than the one actually performed for the patient • Issue bills for each stage of a procedure and treat them as separate procedures • Accepting kickbacks for patient referrals to other hospitals or doctors • Attracting members by not collecting the required deductible • Billing a patient more than the copayment amount for services that were covered fully in the insurance table of benefits. • Filing claims for services or medications not received • Forging or altering bills or receipts • Using someone else's coverage or insurance card. HOW TO AVOID AND PREVENT HEALTH INSURANCE ABUSE AND FRAUD? Some easy ways to help you protect yourself from health insurance abuse and fraud, and keep costs down for all parties: • Ask questions about the medical services you are receiving, such as: Why are they needed? How much does it cost? • Please ensure that for each visit to a doctor you sign one form given to you by the provider • Be careful about disclosing your insurance information. Protect your Membership ID card and do not give it to someone else to be misused as it represents your benefits and limits. • Let us know if a provider has a practice of waiving copayments or deductibles. REPORT SUSPECTED ABUSE TO BUPA ARABIA