CS Healthcare's Fee Schedule set the most the society would pay a consultant and an anaesthetist for each operation, procedure or test, and a consultant was free to charge more. That schedule is now out of date: since 1 January 2021 CS Healthcare's policies have been with Bupa, so for a plan that began with the society, the fee limits on a claim today are the ones in your current Bupa policy papers, not the old society's list. If you are trying to make sense of a consultant's bill, or looking for cover now that CS Healthcare's plans are no longer sold, an FCA-authorised broker can take you through how fee limits work for your own plan, and you can request that call, at no cost, with the form on this page.
What the society's fee schedule was for
CS Healthcare was a friendly society. The Prudential Regulation Authority confirmed the transfer of its insurance policies to Bupa Insurance Limited, and Bupa said in a press release of 17 December 2020 that the transfer would go ahead on 1 January 2021. Before then, the society's FAQ page, as archived on 2 December 2020, answered a question headed "What are customary and reasonable fees?" with these words: "These are the maximum amount we will pay towards the fee your consultant and anaesthetist will charge for an operation/procedure/diagnostic test. These fees are listed on our Fee Schedule."
So the schedule was a ceiling on the insurer's payment for each operation, procedure or test, set separately for the consultant and for the anaesthetist. It did not set what a consultant could charge. The page went on: "Specialist/Consultants can legally charge a patient whatever they wish and while the majority will charge within our guidelines, a small minority may not." It added that the society would settle the fees on eligible claims "which we consider customary and reasonable, as per our Fee Schedule".
The page also explained that procedures were classified with CCSD codes, "a common set of codes and descriptions, used across the healthcare industry by all health insurers and providers", so that the code could be checked against the policy terms. The amounts themselves sat in a separate medical fees section of the society's website, and they belonged to cover that has since moved to Bupa, so an old CS Healthcare figure may not match what a claim pays today; Bupa, as the insurer now holding the policy, is the one to ask for the limits that apply to you.
CS Healthcare consultant recognition, and who decides it now
Consultant recognition is whether an insurer accepts a named specialist for a claim. The society's FAQ page said its "your choice" plan let members choose a hospital from a directory of over 300, using one of two hospital lists, and it described fee limits per procedure. Whether an individual consultant counted as recognised is a different question, and a former member should not assume either answer. A broker can go through how that works for a policy like yours on a free call-back, requested with the form on this page.
For a plan that began with CS Healthcare, that question now goes to Bupa. The transfer took effect on 1 January 2021, and Bupa's August 2020 announcement said members would gain wider access to its health and wellbeing support after their first or second renewal, so your latest Bupa renewal notice and policy wording are what decide which consultants and fees a claim covers now.
How a fee limit becomes a shortfall
A shortfall is the gap between what a consultant charges and what the insurer will pay. With a schedule like the one above, the sum works in three steps: the consultant's bill is compared with the schedule amount for that procedure code; the insurer pays up to that amount, if the claim is eligible; and whatever is left is a matter between you and the consultant.
Two things are easy to mix up with it. Your excess comes off an eligible claim as a separate deduction, and the society's FAQ described a co-payment (15% of a claim on its HealthBridge plan, capped at £250 a claim) as another. Neither is a shortfall. The comparison between a bill and a schedule limit is the only part that depends on the consultant. Anaesthetists, surgeons and hospitals also bill separately, so a shortfall can arise on one bill and not another; consultant fees, shortfalls and fee-assured labels sets out that general picture across insurers.
Steps for vetting a consultant
- Check the insurer named on your latest renewal notice and policy schedule. For a plan still running from CS Healthcare days, that is Bupa, and its fee limits are the ones that apply.
- Get the consultant's name and the procedure or test they propose, then ask the insurer's claims team whether that consultant is accepted under your plan and what it will pay for the procedure.
- Ask the consultant's secretary for the fee for the consultation, the operation and the anaesthetist, in writing, before you agree to treatment.
- Compare the two. If the consultant's fee is higher than the insurer's figure, the difference is yours to pay unless the consultant agrees to charge within the limit.
- Keep the insurer's confirmation, with its date, with your papers.
Keep the order of those steps: the written estimate and the insurer's confirmation both need to exist before the procedure date, because after treatment the bill is already fixed. A consultant who has quoted a fee for the whole episode, including follow-up appointments, makes the comparison far easier than a bill that arrives in pieces.
None of this is medical advice: it is about money, not about which treatment or which doctor is right for you, which is for your GP and specialist.
Questions worth asking before treatment
- Can I see Bupa's fee limit for my procedure before I book it?
- Is my consultant, and the anaesthetist they use, accepted by my insurer for this procedure?
- What is the insurer's limit for the exact procedure code, and what is the consultant's quote?
- Will my excess or any co-payment come off before or after the fee limit is applied?
- If I pay a shortfall, does it count towards any annual limit on my plan?
A plan that began with CS Healthcare is now a Bupa policy, so the answers come from Bupa's wording, not the society's old FAQ. When you want a second pair of eyes on your actual schedule, leave your name, age band, phone number, email and postcode on the form on this page; details of your policy are for the call itself.
Questions readers ask about CS Healthcare fees
Can I still get a CS Healthcare fee schedule?
Not from CS Healthcare: its old web address now redirects to Bupa's website, and its policies moved to Bupa on 1 January 2021. For a policy that began with CS Healthcare, Bupa is the insurer to ask for the fee limits that apply.
Does the schedule mean my consultant must charge that amount?
No. According to the society's FAQ, consultants can charge what they wish. The schedule limited what the insurer would pay.
What is a CCSD code and why does it matter?
It is a code for a type of operation, procedure or test used by insurers and providers. The code is how a claim is matched to the policy terms and, for a fee-limited plan, to a payment limit, so ask for the code when you get a quote from a consultant.
Does the old fee schedule still protect me from a shortfall?
A schedule only limits what an insurer pays; it never limited what a consultant could charge, so no schedule on its own prevents a shortfall. What protects you is checking the fee against your own insurer's current limit before you agree to treatment.
Who do I ask if my consultant's bill looks higher than expected?
Start with your insurer's claims team, which for a former CS Healthcare policy means Bupa's, and ask what it will pay for that procedure code.