Benefits or Fees
This issue came up during a recent meeting with a consultant surgeon. The question was how are fees accounted for against a benefits package. How does this possibly create a shortfall?
Consider the total benefits payable under a patient’s insurance policy. For example, the benefits payable may be £100. It could be considerably more as will the possible fees mentioned below.
To continue, however, against such a benefits package, fees may be deducted as follows:
The patient attends for an initial consultation. That costs £20. Therefore the £20 is paid out and the total benefits figure reduces to £80. The benefits accumulator reduces to £80
Subsequently, the patient requires a surgical episode. That costs £50. This too is paid out. The benefits accumulator, therefore, reduces to £30. But of course, the hospital tenders their account (say £20) as does the gasman (£15).
The benefits accumulator, therefore, further reduces to ZERO. Thus the benefits package is equal to the fees charged.
However…
If the initial consultation fee is £21, the surgical episode fee £51, the hospital account £21 and the gasman’s account £16 then the total fees total is £109 against a total available benefit package of £100.
There is consequently a shortfall of £9
Thus, if when the fees are calculated against the benefits accumulator they exceed the total available, a shortfall will be created.
And the consultant gets an invoice for the £9 shortfall. This £9 has to be paid by the patient.