So patient arrives for the consultation without a pre-authorisation.
What should the private practice do?
Ask the patient to ring their insurance company and obtain the pre-authorisation. But….
Communication breakdown
If the consultation is for Thursday October 14th and the patient does not call until Monday October 18th, the patient must tell the insurance company.
In this example, the patient did not tell the insurance company which date.
When MHM raised the invoice, it was declined.
The consultation was before the date of the pre-authorisation.
If the insurance policy that won’t allow the backdating of a pre-authorisation there will be more difficulties.
In this case an invoice is sent to the patient.
Being unreasonable?
The insurance company is not being unreasonable.
The patient is incurring a liability on their behalf.
The insurance company knows nothing about it. But ultimately the patient is liable for the consultation and thus the invoice is sent to the patient.
The patient rings up (normally upset) and points out they have insurance.
Numerous phone calls between the patient and the insurance company follow.
It would have been better IF the patient had told their insurance company the consultation is for a specific date.
If this is happening to you, it’s an issue you must address.
Otherwise you will spend 15 – 30 mins just sorting this one problem out!
pete@medicalhealthcaremanagement.co.uk