A group of surgeons I know is having problems getting paid by insurance companies.
Not just an individual insurance company but all insurance companies.
More specifically or so the surgeon’s practice manager claimed, there were many invoices unpaid by insurance companies 3 months after the consultation or episode date.
Who is at fault?
This was all the fault of the insurance companies who simply do not want to pay.
To be clear this was not the surgeons complaining the fee had been reduced or was incorrect.
This was a case of the surgeons not being paid at all.
I found this odd as in my experience ALL the insurance companies I deal with pay well before 3 months have elapsed.
The solution?
The practice manager therefore altered the patients’ terms and conditions to read “patients will be asked to pay anything not settled after three months from the date of consultation”. This is, in his words “a long stop” and would prevent the issue arising.
I’m not convinced however putting such a plaster over the wound is the correct action to take.
I’m definitely not convinced a “long stop” will prevent the problem because it will allow the invoices to become three months old and then do something about them. More importantly, it is based ON AN ASSUMPTION
It assumes the invoices are being delivered to the insurance company within three months of the consultation (or for that matter surgical episode date) anyway.
Don’t Assume
I raised the following two points with the consultants and their Practice Manager:
The patient is ultimately liable for payment anyway.
The contract is between the consultant and the patient. Not the consultant and the patient’s insurance company.
Whilst it is useful to insert the “three months” clause it would have been better to add it was ultimately the patient’s liability anyway as well.
Is the “three month’s clause” not missing the point entirely?
WHY aren’t the invoices being paid within three months?
It’s this second point that is the more relevant of the two.
Establish the Facts
Insurance companies are NOT the enemy.
Of course, I disagree with many of their fee reductions.
I also disagree when they decree certain multi procedures are now deemed to be part and parcel of each other.
They also make mistakes sometimes. The reason for my disagreement is obvious.
I’m here to get the maximum amount of revenue for my clients.
Anything that reduces such revenue is not good.
Nonetheless, insurance companies should not be treated as if they are the enemy.
Insurance companies WILL settle a claim within 3 months. I can honestly say I don’t have a single invoice for one of my clients sent to an insurance company still unpaid after three months by the insurance company.
So why are the group of surgeons referred to earlier having problems and introducing the “three-month” rule?
The Problem Shouldn’t Have Even Been there
Without even drilling too far down into how and when the surgeons were invoicing, I can tell you the probable cause and why they subsequently feel the rule is necessary.
- Invoices are not being raised immediately or at worse within seven days of the episode date
- Invoices that are raised are incomplete and inaccurate
That is why the invoices are not being paid earlier than the consultants are currently experiencing.
It is all about getting it right the first time.
First time means having a clinic list or a theatre list invoiced promptly with all the details required by the insurance company appearing correctly on the invoice.
Putting the effort in upfront always generates the best results.
It may be tiresome and it may be an inconvenience to have to stop, make a phone call so you DO have the correct details but it pays in the long run.
Get a Process
Its also all about 30 days after the invoice has been transmitted to an insurance company if it is still unpaid, getting them on the phone and asking if there is a problem.
If there is, it gets sorted immediately.
An invoice should not be allowed to be dated more than three months from the episode or consultation date.
Consider it this way.
If you invoice quickly and invoice correctly, the number of potential issues which may delay payment reduces considerably.
You simply must make it easy for a private medical insurance company to deal with your invoices.
I actually said that to a consultant surgeon recently who wasn’t sure he agreed until I asked him if he liked money or not?
I rest my case.
As regards the consultants who have now introduced the “three-month rule” the rule itself should be entirely unnecessary.
The cause of the problem should be examined and steps are taken to prevent the invoices from becoming more than three months old.
pete@medicalhealthcaremanagement.co.uk