A question from a group of consultants who referred patients to each other and they had problems getting paid.
Following a conversation with the insurance companies concerned the cause of the issue was clear.
The consultants assumed that the pre-authorisation confirmed the patient could see any consultant. They were wrong.
Specific consultant.
A patient is referred normally to a specific consultant by their GP. Alternatively, of course, the patient may contact their insurance company. The insurance company might refer them to a specific consultant.
In either case, a specific consultant is involved.
If that consultant then refers the patient to a colleague, it is unsafe to assume the pre-authorisation will stand. It may not.
What do you do?
In a perfect world, the patient will contact their insurance company and ask if the pre-authorisation can be transferred.
Normally this is not a problem.
But what do you do when the patient hasn’t done so?
You need to speak to the insurance company concerned and explain why the pre-authorization should be transferred.
In other words, the insurance company up to the point they are told of a second consultant is unaware of his involvement. When the insurance company receives an invoice from a different consultant, they are confused. They will either delay payment or worse decline the invoice.
If this happens you will have no choice but to sort it anyway.
Be pro-active
If you do need to refer a patient to a colleague or a patient has been referred to you by a colleague make sure the patient’s insurance company is aware.
On the occasion(s) I’ve had to do this, either a new pre-authorisation has been issued or an amendment to the existing pre-authorisation made.
Insurance companies are NOT the enemy. They will help if they can.
It is unreasonable though to expect them just to pay out if they receive it from a different consultant to the one expected.
You can transfer have a pre-authorisation transferred to a colleague but speak to the patient’s insurance company first, please.
pete@medicalhealthcaremanagement.co.uk