A pre-authorisation can be backdated.
In by far the majority of cases, your patient will obtain authorisation in advance of the actual date. But sometimes, the patient arrives and hasn’t obtained a pre-authorisation. First question: should you see the patient?
Of course, you should; patient care must come first.
But what do you do? It does happen, it shouldn’t but in the real world, it does. How should the private surgeon handle it then? Ask the patient to ring his/her insurance company and obtain the pre-authorisation. But….
Communication breakdown
If say the consultation was on the 8th and the patient does not call the insurance company until the 15th, the patient should make sure the insurance company knows when it took place. In this example, the patient did not tell the insurance company it was a week earlier. When MHM tried to invoice, it was declined as the consultation was before the date upon which 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 even more difficulties. In which case an invoice for the initial consultation should be sent to your patient.
This is not the insurance companies being unreasonable.
Speak to the insurance company
If you think about it, the patient has incurred liability on behalf of the insurance company. But the insurance company knows nothing about. Ultimately the patient is liable for the consultation fee of course thus the invoice is sent to the patient. The patient rings up (normally quite upset).
They point out they are insured and are indeed covered for consultations in their view.
Numerous phone calls between the patient and the insurance company and the issue gets sorted. The invoice is submitted to the insurance company and its paid in full. This time it was anyway.
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 with the patient, the correct authorisation numbers have been obtained.
If this is happening to you, it’s an issue that should be addressed and prevented otherwise you may spend 15 – 30 mins just sorting this one small problem out!
pete@medicalhealthcaremanagement.co.uk