The patient arrives for the consultation but hasn’t obtained a pre-authorization from their insurance company.
Should you see the patient?
Yes; patient care must come first.
But the patient does not have a pre-authorization?
Ask the patient to ring his insurance company and obtain the pre-authorization immediately.
2 days ago
If, say the consultation was on October 28th and the patient calls the insurance company on October 30th, they must ensure the insurance company knows when the consultation took place.
In this example, the patient did not say it was two days earlier.
When MHM tried to invoice, it was declined as the consultation was before the authorized date.
What to do?
This is not the insurance companies being unreasonable.
The patient has incurred liability on behalf of the insurance company, which the insurance company knows nothing about.
Ultimately the patient is liable for the consultation fee of course so an invoice is sent to the patient.
The patient rings up and points out they are insured and are covered for consultations in their view.
Numerous phone calls between the patient, the insurance company later, the issue is resolved.
The invoice is sent to the insurance company and its paid.
Get it right at the start.
It would have been paid a lot easier IF the patient had been advised to advise their insurance company the consultation was for a specific date.
If this is happening to you, it’s an issue you can prevent.
Or you can spend 15 – 30 mins just sorting this out!
pete@medicalhealthcaremanagement.co.uk