One of my Orthopaedic surgeons saw a patient in clinic last week for a follow-up consultation.
The follow-up was after the surgical episode which took place about three weeks earlier.
Declined
I was surprised when the invoice came back as declined.
It would appear the follow-up consultation had not been authorized.
But I can’t actually remember the last time an invoice for a post-surgical follow-up was declined as “not authorized”
Put simply its pretty standard for when the surgical episode is authorized for a follow up to be authorized too.
So I called the insurance company concerned.
By Mistake.
There was no reason why the invoice should be declined. There was nothing the matter with it.
So what had happened?
The insurance company had made a mistake.
No big deal.
At the end of the day and despite what some people may think, insurance companies are actually staffed and indeed are themselves human.
Insurance companies are very quick to point out when they have been overcharged. They are equally efficient at pointing out when an episode or consultation is not covered under the patient’s policy either.
But are they equally quick to correct an error when they have made one?
Actually yes they are. But that does depend on two fundamental questions?
Has their mistake been spotted?
Has anyone taken the trouble to call them and point the error out to them?
If the answer to the above two questions is negative, then how realistically can you expect an insurance company to spot and correct errors.
In theory, they should of course but in the real world, they probably won’t.
Having said all that there is one other question that needs to be asked BEFORE you contact the insurance company regarding a potential mistake on their part.
Are you checking what they say as being incorrect is actually incorrect?
pete@medicalhealthcaremanagement.co.uk