A pre-authorisation can be backdated.
The patient will obtain authorisation for a consultation in advance of the actual date normally. But sometimes, the patient arrives for the consultation without it. First question: should you see the patient?
Yes. Patient care comes first.
But what do you do if the patient does not have a pre-authorisation? How should the private surgeon handle it? Ask the patient to ring their insurance company and obtain the pre-authorisation as soon as they can. But….
Communication breakdown
If the consultation was on November 8th and the patient does not call the insurance company until November 15th, the patient should make sure the insurance company knows. In this example, the patient did not tell the insurance company it was a week earlier. When MHM tried to invoice, it was declined. The consultation was before the date the pre-authorisation was issued.
If the patient holds an insurance policy, which will not allow the backdating of a pre-authorisation you’ll have more difficulties. In which case an invoice should be sent to your patient.
Being unreasonable?
The insurance companies are not being unreasonable.
The patient has incurred a potential liability on behalf of an insurance company. The insurance company knows nothing about it though. But ultimately the patient is liable for the consultation. Thus the invoice is sent to the patient. The patient rings up (normally quite upset) and points out they are insured and are covered.
Numerous phone calls between the patient and the insurance company follow. The invoice is re-submitted to the insurance company and its paid in full.
It would have been paid a lot quicker IF the patient had been asked to advise their insurance company the consultation was for a specific date. When the patient arrives for the consultation it is then simply a matter of confirming the correct authorisation numbers have been obtained.
If this is happening to you, it’s an issue that should be addressed.
Otherwise you may spend 15 – 30 mins just sorting this one problem out!
pete@medicalhealthcaremanagement.co.uk