Many times either the patient or the consultant has queried why an account has not been paid in full citing a correct pre-authorisation was obtained before the episode or consultation.
The issue concerns the interpretation of the phase “pre-authorisation” and what it really means.
Pre-authorisation confirms that the patient has a policy with a private medical insurance company subject to the terms and conditions of the specific policy held. In other words, it does NOT guarantee full payment. For example: there may be an excess of £250 on the policy or there may be a benefit cap on the policy.
This is only right and proper if you consider the issue from the viewpoint of a private medical insurance provider.
What is clear is that over the last few years, patients or their employers have sought to reduce the cost of private medical insurance by agreeing to a higher excess or a cap on total benefits paid out under their policy. Understandably so. It is not the only reason but it is this, which has caused the increase in deductions i.e. excess and shortfalls – not the reluctance of private medical insurance providers to cover the full cost of treatment despite the issue of a pre-authorisation number.
Yet still, “but it was pre-authorised” is stated as the reason why the patient believes he/she should not be liable for any amounts outstanding.
For confirmation of the true meaning of “pre-authorisation” call any of the big 5 private medical insurance companies and whilst on hold you will hear the message to the effect – “pre-authorisation confirms the patient has a policy subject to the terms and conditions of the policy”
Pre-authorisation does not guarantee full payment. Neither will it stop deductions for excess or shortfalls.
pete@medicalhealthcaremanagement.co.uk