PPP pseudo-partnership agreements - what is "usual and customary"?

Several consultants have received a document from PPP that they have been asked to sign. This requires them to agree to a level of fees which PPP call "usual and customary" and not to request the patient to make up any shortfall. Of course PPP do not actually state what level of reimbursement they will actually make and therefore they are totally in control of what they state is "usual and customary". An individual consultant has no knowledge of the actual fees being charged generally (and reimbursements made by other insurers do not always correspond).

The LCA has asked PPP to furnish details of actual reimbursements over the last 3-5 years to see what inflationary increases have occurred. In addition the LCA has asked what future inflationary increases will be guaranteed and what extra allowance is made towards the fees for London Consultants, given the much higher running costs of practice in the capital. PPP will not give any backdated information, will not agree to any future rises of patient reimbursement and deny that there is anything different about London consultant expenses and charges.

If any such document is signed by a consultant it will in our view
commit them to a subtle form of partnership and remove their ability to
bill the patient directly.

All patients should be warned before any procedure, investigation or treatment of the likely financial implications although in many cases the nature of the patient's condition and thus the treatment is unclear. Once again the LCA repeats its position of NOT encouraging excessive or unreasonable fees and reminds consultants that they should be as open as possible.

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