A group of consultants who refer patients to each other asked this question. They always seemed to have problems getting paid.
The cause of the problem became clear following a conversation with the insurance companies they were invoicing.
The consultants were assuming the pre-authorisation meant the patient could see any consultant with the group.
This is not always correct.
A patient is normally referred to a specific consultant. Alternatively, the patient may contact their insurance company. Their insurance company may refer them to a specific consultant. A specific consultant is involved in either case.
If the consultant refers that patient to a colleague, it is unsafe to assume the pre-authorisation can be used by their colleague. The pre-authorisation may apply to a specific consultant.
In a perfect world, the patient should have already contacted their insurance company. They should have asked if the pre-authorisation can be transferred to the second consultant. Normally this is not a problem. But what do you do when the patient hasn’t contacted their insurance company? And what do you do if you now wish to invoice?
You should speak to the insurance company concerned.
The insurance company up to the point they are notified of a second consultant, are unaware of his/her involvement. So when they receive an invoice from a different consultant than they expected, they are confused. They could either delay payment or worse still they may refuse to pay the invoice.
If this happens you have no choice but to sort it out.
It’s more sensible if you do need to refer a patient to a colleague to make sure the patient’s insurance company are aware of this. On the occasion(s) I’ve had to do this, it has resulted in the issue of a new pre-authorisation against the second consultant. However, in some cases, an amendment to the existing pre-authorisation has been made and the issue resolved.
Insurance companies are NOT, as I’ve said before, the enemy.
It is unreasonable to expect them just to pay an invoice from one consultant if they receive an invoice from a completely different consultant to the one they expected originally.
pete@medicalhealthcaremanagement.co.uk
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