This comes up more often than you would think.
The patient fully completes the registration form but when you invoice either you can’t actually raise an invoice or after you have done so the invoice is rejected. In both cases the stated reason is that the patient’s insurance policy has expired. Now what?
You must speak to the patient for ultimately the patient is liable for the invoice.
It may well be the patient has changed insurance company or a new policy has been set up. In both cases that is fairly easy to correct. However if there is no current insurance policy in place, then as mentioned above the patient owes the money.
All of which negates a very important question and one that should be asked…
How did the patient manage to obtain treatment without the practice knowing their policy had expired?
Was the patient asked when the policy would run from or more importantly too.
This last question really identifies a number of potential problems before they actually occur for its quite an important piece of the jigsaw.
During October 2016 I faced this situation on four separate occasions.
In each case I had to contact the patient and in one case obtain payment direct by card; in the other three I had to re-invoice a completely different insurance company. Yet if the patients had been asked when did their policy expire the problem would not have arisen and payment would have been received much quicker and without additional costs.
The cause of the issue was a failure to ask the patient to confirm their policy details or better still to bring their policy documents with them when they first attend for consultation. Insurance policy documents do state when the policy runs from and too. They also have the policy number on them together with all the details you will need to correctly raise an invoice.
I was discussing this very issue with a consultant a couple of days back. His view was simple. If the insurance company do not accept an invoice, an invoice can’t be raised or the invoice is declined then as payment is ultimately the patient’s responsibility anyway where is the problem?
There isn’t a problem save by not getting policy dates and all the relevant details correct all that will happen is the oustanding invoice will be added to the “to be actioned” pile.
But are you confident the “to be actioned” pile is actually being actioned?
Do you have all the pieces of the jigsaw?
pete@medicalhealthcaremanagement.co.uk