An MHM client has this problem currently.
Pre-Authorisation
In the majority of cases, her patient obtains authorization for a consultation.
But sometimes, a patient arrives and hasn’t done so. First question: should she see the patient?
Yes, because patient care comes first.
What does she do about the pre-authorisation?
Ask the patient to ring the insurance company and get authorization.
But….
Back Dating
If the consultation was on March 8th and the patient does not call the insurance company until March 15th, the patient needs to tell the insurance company knows when it took place.
In this example, the patient did not tell the insurance company it was a week earlier. When MHM invoiced, it was declined as the consultation was before the date the pre-authorisation was issued.
If the patient holds an insurance policy, which does not allow the backdating there will be even more difficulties. In this case, an invoice for the initial consultation is sent to the patient.
Unreasonable
This is not the insurance companies being unreasonable.
The insurance company knows nothing about the consultation.
Ultimately the patient is liable for the fee and that is why the invoice is sent to them. The patient subsequently rings up (normally upset) and advises they are insured.
Numerous phone calls between the patient and the insurance company follow. The issue is resolved.
It is quicker IF the patient is told when they book the consultation to advise their insurance company the consultation is for a set date.
If this is happening to you, it’s an issue that you should address.
Otherwise, you spend 15 – 30 mins sorting this one problem out!
pete@medicalhealthcaremanagement.co.uk