The patient arrives for the consultation. He hasn’t obtained a pre-authorisation from his/her insurance company.
Should you see the patient?
Yes, of course, you should; patient care must come first.
But the patient does not have a pre-authorisation! It does happen, it shouldn’t but in the real world, it does.
How should this be handled then? Ask the patient to ring his/her insurance company.
What if they don’t?
The chances are the insurance company will decline to pay any of the invoice.
This is not the insurance companies being unreasonable.
The patient has incurred liability on behalf of the insurance company, which the insurance company knows nothing about.
Ultimately the patient is liable for the consultation fee of course so an invoice is sent to the patient.
The patient rings up (normally quite upset) and points out they are insured and are covered for consultations in their view.
Numerous phone calls between the patient, the insurance company later, the issue is finally resolved.
The invoice is submitted to the insurance company and its paid in full.
Get it right at the start.
It would have been paid a lot quicker and without the hassle IF the patient had been asked by the consultant to advise their insurance company the consultation was for a specific date.
If this is happening to you, it’s an issue you can address and prevent otherwise you may spend 15 – 30 mins just sorting this out!!
pete@medicalhealthcaremanagement.co.uk