This is actually happening now.
MHM, on behalf of a client, recently invoiced a private medical insurance company for a T7915 performed on January 23rd.
Fee Calculation
Per normal, MHM checked the fee schedule of the insurance company and confirmed the correct fee was £750.
Only then was the invoiced raised for £750
It came as a surprise today however to see a lesser amount of £620 has been paid.
£130 less.
It is even more surprising to read on the remittance the reason why it is less!
‘We cannot pay this amount in full as we do not cover consultations made within 10 days of a surgical episode”
Yes, I know you don’t.
But the fee is for the procedure alone and nothing to do with a follow-up consultation.
Moreover, £130 is the fee for an initial consultation and not a follow-up consultation.
Waiting
So I’m currently on hold to the insurance company concerned and have been for the last 35 minutes waiting for them to even answer the telephone.
In fact, I’ve been on hold so long, I can draft this blog post before they even get round to answering the phone!
Observations
If remittance advices aren’t checked, insurance company errors like this will be missed and you will be out of pocket.
This time £130 out of pocket.
Further, I’m not in the slightest bit interested in hearing a recorded message telling me how busy an insurance company is.
Nor am I interested in being told: “our team is working hard to get to you”.
What I am interested in is how an insurance company can make such a basic mistake as this?
When will the insurance company answer the phone so I can sort this out?
And how many more mistakes are there like this where ultimately the consultant pays the price and is out of pocket?
Lesson for you
This is why it’s SO important to check every single payment made to you.
are you??
pete@medicalhealthcaremanagement.co.uk
p.s. after 42 minutes the call was answered. It will now take 15 working days to respond to my query. THREE WEEKS!!!
But I’m told it won’t take 3 weeks, it takes 15 working days.
I give up.