An MHM client recently performed a certain surgical episode. The surgery was something he’d done many, many times before with invoices being sent and paid.
Normal stuff
Pretty standard in other words.
One particular insurance company paid £300 for the procedure. Before sending the invoice I’d checked per normal this was the correct fee.
It was.
When the payment remittance arrived from the insurance company I was, therefore, most puzzled to see the fee had been reduced to £240.
Hang on a sec?
It was not a shortfall. It was not excess. Therefore any shortfall could not be passed on the patient.
According to the remittance supplied by the insurance company, the fee of £240 was in line with the normal published fees.
Except according to the insurance company’s own website, it wasn’t.
So I called the insurance company and asked them to explain.
The reply was wonderful. The fee had obviously been reduced between the date I had invoiced and today.
I have a view on that argument and it is not a positive one.
However, as I pointed out, my client had performed the same surgical episode on different patients both before and AFTER this one. A fee of £300 had been paid in all cases.
Also, I have more than ONE client who, as it happens, perform the same procedure although in different parts of the UK and been paid £300 since the date of this episode as well.
Still not to be beaten, the insurance company suggested the specific consultant surgeon I was dealing with as regards this case had agreed, as part of his updated recognition process, to accept a lower fee i.e. £240. That came as complete news to me! It came as a shock to the Consultant Surgeon too!
So I called the insurance company back save this time I asked for my normal contact there.
After the normal pleasantries, I explained my predicament.
Oops Moment
The phone went quiet for a while but then my contact came back on the line with the immortal “Oops – we got that one wrong”
It’s a good job I was paying attention.
I really did have to smile.
pete@medicalhealthcaremanagement.co.uk