What on earth is that?
Couple of examples recently where consultants who have tried to base their fees on the best rate available across the PMI estate spring to mind. Take the consultant who realises that PMI company Num 1 pay £300 for a procedure whereas PMI company 2 pay £400. He therefore decrees he will charge PMI Company 1 the higher PMI Company 2 rate each time he performs that procedure.
Great idea. Right up to the point PMI company 1 who the patient is actually insured with receives the invoice for the higher amount. They will decline to pay that fee and most likely will shortfall it. But, replies the Consultant, no problem because the patient is ultimately liable for any shortfall. I know of one consultant who even puts on his website “we use PMI Company 2 rates to calculate our fees and therefore there may be a shortfall which you will have to pay”
Yes, the patient is liable for a shortfall BUT not when the consultant is fee assured he isn’t. Most likely a letter addressed to the Consultant will arrive sooner or later from PMI Company 1 pointing out that such “inappropriate billing” is not acceptable; carry on doing it and recognition is at risk.
It’s incredibly similar to unbundling. Continue doing it over a number of months and for sure eyebrows will be raised. Even if there is no “fee assured” status PMI Company 1 will be well aware of regular and consistent charges that are in excess of their published fee schedule.
Not withstanding the above, of course consultants want the best possible fee for a procedure but attempting to obtain same by “inappropriate billing” is not the smartest way to go about it.
pete@medicalhealthcaremanagement.co.uk