Fee schedule

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Aviva has been actively working with five other major private insurers as part of the Clinical Classification and Schedule Development (CCSD) group since their launch in 2005. The group was formed to oversee the improvement of coding standards used in the private medical sector.

The key initiative was to develop a common set of codes and descriptions across the industry. Codes have also been brought up to date to more accurately describe today's medical practice. Codes have been added, split, merged or deleted to reflect the current set of procedures practised for that speciality.

While the CCSD codes are used by all insurers, the associated fees are set by each individual insurer separately.

These fees are based on relativities which reflect such factors as complexity, duration and comparing one procedure with another. Where possible, we have considered information derived from other schedules circulating in the United Kingdom and also from our claims experience.

We do recognise that due to evolving medical practice, the complexities of procedures may change slowly over time. We do keep our approach to specialist fees under continuous review and welcome input from professional bodies in this respect.

Specialist fees represent a significant element of total private medical insurance claims and as such, have a major impact on premiums. For these to remain affordable, doctors, hospitals and insurers must work together to provide quality healthcare at a reasonable and realistic cost.

The fees we pay are set out in our published fee schedule and are calculated based on the clinical nature of each procedure and what we believe to be fair and reasonable. As independent practitioners your fees are set at your own discretion; however, we will only pay you up to the maximum stated in the fee schedule. Our customer will be liable to pay you any shortfall. It is therefore important that you tell us whether you will adhere to our fee schedule so that we can advise our customers of any potential shortfall and enable them to make an informed choice about their treatment.

If the shortfalls our customers must pay to you are, in our assessment of pricing, continually excessive, unreasonable and not substantiated with clinical evidence for the procedures performed, we may withdraw your recognition as an Aviva recognised provider.

Important Changes to our Consultation fee

From December 2016 onwards, our customer policy terms and conditions will be changing to allow for shortfalls on consultation fees. As a result, we have increased our published fee from £144 to £204 for initial and £108 to £144 for follow-up.

Consultants as independent practitioners are able to charge whatever fee they wish, but we do need to be able to advise members in advance of treatment whether they are likely to incur a shortfall and therefore it is essential that you let us know your preference. To discuss further, please call 0800 433 4514 or email us at hcsfr@aviva.com

Consultation fees

You agree to charge appropriate consultation fees proportionate to the level of care and investigation for each patient, and only up to the maximum stated in the fee schedule.

All room and equipment charges are inclusive of the consultation fee and no other charges should be made.

Information provided to Aviva by specialists will be processed for the purposes of policy and claims administration and associated activities including payment for your services, maintenance of your details and fraud prevention. The data controllers are Aviva Health UK Ltd, Aviva Insurance Limited and Aviva Life and Pensions UK Limited. Calls and emails may be recorded and/or monitored.

© Aviva Health UK Limited 2012. This fee schedule may not be reproduced without permission.

This work is based on the CCSD Schedule of Procedures © The Clinical Classification and Schedule Development Group 1999-2005.

Material contained in the Office of Population Censuses and Surveys Classification of Operations and Surgical Procedures Consolidated Fourth Revision, is © Crown Copyright 1990 and has been reproduced by kind permission of the Controller of Her Majesty's Stationery Office and the NHSIA.

No responsibility is accepted by the Office of Population Censuses and Surveys of Her Majesty's Stationery Office for the accuracy or comprehensiveness of such material.

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