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Our schedule of procedures and fees

Our schedule of procedures and fees contains important information about billing and payments.

Our fee structure

We set fees that we will pay for procedures so that we can deliver the quality healthcare that our members need and keep premiums affordable for them. The standard fees are set at reasonable levels for procedures and are based on work undertaken by the Clinical Coding and Schedule Development group (CCSD).

Fees outside our fee structure

Specialists that we have recognised since 2008 have accepted our fees as full reimbursement. This provides our members with reassurance on payment of fees.

A very small number of specialists that we recognised before 2008 charge fees higher than we will reimburse. This means members using these specialists may have to pay additional costs towards their treatment. We find that many patients decide to choose a different specialist if they think this is likely.

If one of our members does want to find a different specialist, they can ask us to search for suitable alternatives using our Fast Track Appointment Service. In most cases, we will be able to suggest up to three suitable specialists from our list of fee-assured specialists.

In all cases, medical necessity and choosing the right specialists for the condition or required procedure are the key factors.

Fee Uplifts/ Coding Queries/ Multiple Specialist Requests

For all queries to the Specialist Fees Team (Uplift requests, coding queries, multiple specialist requests) please complete the Specialist Fees enquiry form.

Our schedule of procedures and fees

The Schedule of procedures and fees contains codes for procedures for which our policies provide benefit and is based on work undertaken by the Clinical Coding and Schedule Development group (CCSD).

To fully understand our approach to fees you will need to read the introduction to the Schedule of Procedures and fees. This contains important information regarding our billing principles.

We publish two Schedules of Procedures and Fees that apply to different Specialist recognition statuses (Fee Approved / Fee Limited). If you are unsure of your status please contact the Specialist Fees and Coding Team on 01892 772160.

You can view our full Schedule of Procedures and Fees for Fee Approved Specialists here.

You can view our full Schedule of Procedures and Fees for Fee Limited Specialists here.

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For our recognised healthcare professionals only.

Our terms of recognition

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