Following yesterday’s blog, I received two emails from consultant surgeons regarding the relationship between benefits and fees. More specifically how fees are accounted for against a benefits package and how this may lead to the possible creation of a shortfall.
Consider the total benefits payable under a patient’s insurance policy. For example: the benefits payable may be £100. Obviously it could be considerably more as will the possible fees mentioned below.
To continue however, against such a benefits package fees are deducted as follows:
The patient attends for an initial consultation at a cost of £20. Therefore the £20 is paid out and the total benefits figure reduces to £80. Subsequently, the patient requires a surgical episode at a cost of £50. This too is paid out and the benefits accumulator therefore reduces to £30. But of course the hospital tenders their account (say £20) as does the gasman (£15). The benefits accumulator therefore further reduces to ZERO. Thus the benefits package is equal to the fees charged.
However….
If the initial consultation fee is £21, the surgical episode fee £51, the hospital account £21 and the gasman’s account £16 then the total fees total = £109 against a total available benefit package of £100.
Thus, if when the fees are calculated against the benefits accumulator they exceed the total available. Thus a shortfall will be created and the consultant surgeon advised a payment in respect of the shortfall required from their patient.
pete@medicalhealthcaremanagement.co.uk