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Clinical Coding and Schedule
Aviva has been actively working with four other major private insurers as part of the Clinical Coding 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.
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 015 7756 or email us at firstname.lastname@example.org
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.