In by far the majority of cases, your patient will obtain authorisation for a consultation in advance of the actual date.
But sometimes, the patient arrives for the consultation without a pre-authorisation. First question: should you see the patient?
Of course, you should. Patient care must come first.
So what do you? How should the private surgeon handle it then? Ask the patient to ring his/her insurance company and obtain the pre-authorisation as soon as they possibly can. But….
Communication breakdown
If the consultation was on February 8th and the patient does not call the insurance company until February 15th, the patient should make sure the insurance company know when it took place. In this example, the patient did not tell the insurance company it was a week earlier.
Thus when MHM tried to invoice, it was declined. 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 more difficulties. In this case, an invoice for the initial consultation should be sent to your patient.
This is not the insurance companies being unreasonable.
The patient has incurred a liability on behalf of the insurance company. But the insurance company knows nothing about it. Ultimately the patient is liable for the consultation fee of course thus the invoice is sent to the patient.
But the insurance company knows nothing about it. 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) and points out they are insured and are indeed covered for consultations in their view.
Ultimately the patient is liable for the consultation fee. Thus the invoice is sent to the patient.
Numerous phone calls between the patient and the insurance company and the problem is sorted. The invoice is submitted to the insurance company and its paid in full. This time it was anyway.
Stop the problem at source.
It would have been paid a lot quicker IF the patient when they made the consultation appointment, 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
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