MRI & Bupa

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Blatantly posting here for traffic so yes IABU but hoping someone can help anyone. Sorry it's a bit long.

I've been having issues with my vision for a while (blurriness in one eye a bit like a smear in the centre of my vision). Been to the optician, he couldn't find anything wrong so told me to see my GP. GP isn't really sure what's going on but wants to rule out anything serious like a brain tumour asap so has referred for an urgent MRI.

We have bupa coverage through my partners work & have had for 4 years, it's not classed any kind of tier but it's pretty comprehensive (as much as you can get I think) and doesn't exclude any pre existing conditions but it's about as clear as mud the ins and outs of what you can and can't actually claim for and how you go about claiming.

My GP gave me a referral to our local private hospital for the MRI as he would normally do for an x-ray, ultrasound etc (as my partner has had recently for a liver ultrasound on the same policy in this way). All good until this point.

On ringing bupa they are maintaining a GP cannot refer for a MRI only a consultant can so I need to go back to my GP and get a referral for a consultant (only real option is a neurologist) and for them to subsequently refer for an MRI which bupa would accept (this is all a bit ridiculous as the MRI is 'only' £373 which is nearly what a consultant appointment costs anyway). BUT all private neurologists within 100 miles of where I live are fully booked until end of October which obviously completely undermines the urgency of this scan. Bupa are saying not their problem, will not budge and have told me to self fund or go to the NHS.

Do I have any leg to stand on here?

When I’ve used Bupa I’ve been via a private GP (Babylon), who have been able to refer straight to tests. Maybe because they’re already part of the ‘system’.

Not sure if it works for MRIs, but it might be worth a go?

So I had exactly this a year ago. I was referred to eye casualty by the optician. I was also told the horrific option of a brain tumour (it wasn’t). I said I couldn’t deal with wait and would go private for the MRI.

I tried to get an appointment and had the same issue. It’s because of the exact things the NHS want. With and without contrasts. Brain and orbits etc. I did actually pay but then there would have been issues with who saw and assessed the images. I was trying to get the referral from eye casualty and it caught the attention of a consultant who I think was pretty shocked by the way the doctor has told me only the brain tumour option. Anyhow, he spoke to the radiology team and one of their doctors also worked For a private MRI place. They very helpfully worked out that he could share the images with the team at the hospital and get my results that way. Long story short. Perhaps they have contacts like mine.

I wish you the very, very best of luck. It is utterly traumatic and the loneliest place on earth living in this limbo.

Oh and the MRI will not be £373. It will be more expensive. Just to warn you. Mine was nearly £1000 but they had interest free options.

Where are you based?

I have been with BUPA for years the process has always been a GP referral to a Consultant. Then the Consultant refers the patient for tests and scans. It was always onerous but the system worked OK till the NHS virtually collapsed. The private sector is under extreme strain now. It now takes a long time to see a consultant even privately. As you have unfortunately found out. My DS is currently in the same situation. I have always had to pay myself for the initial Consultant’s appointment then the scans etc were covered by BUPA. Anyway in answer to your question no BUPA won’t budge. If you pay for your initial consultations as I do. I would strongly advise you put that money towards self funding an MRI scan. Good luck OP. This must be very worrying for you and you don’t want to be waiting till the end of October to get sorted so self fund the MRI if you can afford to do so.

Health insurance covers for imaging requested by consultants only.

I was referred by an ent consultant on nhs and had mri scan within two weeks, ironically at the private hospital! That was for ears but no reason your gp cannot make a similar referral to ophthalmology.

The first person I spoke to actually said we could use the private GP (that is also included in our package) for a referral as well but they've subsequently gone a bit fuzzy on this. Sounds like it might be worth exploring. Thank you

It's definitely £373, I have already spoken to the local private hospital and this is their self funding cost. I'm in Cardiff.

It's not an issue of who reviews the images as there already a process set up between the private hospital and NHS GP's where the hospital reviews and reports on the scans to the GP the same way as they would back to a private consultant who would then also have to report back to the GP to re enter the NHS system.

Unfortunately I think this really sadly sums it up, there's just not enough capacity anywhere. Years ago I had an MRI on my back all via a private consultant but that all happened within a month and it wasn't urgent.

It seems like we might be better to withdraw from bupa and use the cost to pay as we go so we're not tied to bupa approved providers either.

The GP feels ophthalmology is fundamentally where I need to be but he's said because I've had the all clear from a normal optician, they won't take the referral until I've had an MRI as they'll bounce it that way initially. I guess all another indication of the system under too much strain decisions are being made based on capacity rather than need.

It is a bit of a faff but if the mri shows anything you are already in contact with a consultant.

Use the private gp to get the referral and then when you speak to bupa for preauthoisation ask if there are any online consults available?

The private gp is online and very quick.

Also, ask for a referral to an optamologist - there might still be something with the eye the optician can't spot.

That’s really good that it’s all set up. I found the trying to sort stuff out super stressful.

Fingers crossed for you.

@OhBeAFineGuyKissMe thank you, good points.

Sorry to jump in again OP but I also agree with @OhBeAFineGuyKissMe. I had a problem with my eye that an optician and a GP failed to diagnose. It was sorted with a referral to a Consultant ophthalmologist. The waiting list for that sort of specialist may be quicker than a neurologist. I am sure they could also refer for an MRI also.

Is it worth finding out how long the NHS wait actually is? I had an urgent MRI referral direct from my GP for similar neurological reasons and it was done within a couple of weeks and the results were back within 8 hours (probably only because they'd found something, otherwise it would have been longer!) I've got to have another one now to check the fat saturation of the mass they've found to ensure its a lipoma and nothing more sinister and that's been booked in for under 3 weeks from the date the GP requested it. I too have Bupa and was going to see if I could use it but even if I could I don't think it would have been much quicker to be honest!

@LG93 I spoke to the hospital yesterday and the wait is between 3-14 weeks for a brain MRI at our hospital. The GP considers it urgent and refers it as such but the hospital will assess the referral and may place it on a different timescale (& unfortunately due to current demand they generally try to minimise urgency). Obviously I'm very much hoping it all turns out to be nothing anyway but the thought of waiting 14 weeks is a bit scary.

@MsFannySqueers that's a good point, I hadn't thought about an ophthalmologist being able to refer for an MRI (& obviously an ophthalmologist is ultimately who my GP thinks I need to see just jumping through all the hoops on route).

You can get a video consultation with any consultant in the uk (which you should be able to get availability for next few weeks) and get the referral.