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    • 26
      Oct
    • (0)
    • By Pete Crutchley


    • Medical Billing News

    Consultation not covered under the patient’s insurance policy

     

     

    digital clock

    Sometimes it can be confusing why an invoice is declined for payment.

    The patient arrived for her consultation. She brought her pre-authorisation number too.

    An invoice for her consultation and the investigatory procedure was raised.

    Invoice declined.

    We were expecting a £200 fee for the consultation and a £75 for the procedure.

    Instead, payment was made for the procedure only. Thus the phone call to the insurance company.

    The invoice was NOT declined because the insurance company had decreed a consultation fee could no longer be charged at the same time as the procedure.

    Nor was it as stated on the remittance that the episode was within 6 months of the previous treatment date.

    Not Covered

    It was because the patient’s policy did not cover consultations.

    There are a number of policies out there like this. Other than asking the patient, they cannot be identified until payment is made.

    In any event, the £200 consultation fee was the patient’s liability.

    Now What?

    What was more relevant is that the issue was identified and actioned.

    Shortfalls/excess can easily build up. Then they are a problem.

    When MHM are contacted and asked to report on the performance of a practice, shortfalls/excess are consistently in the top three problems.

    Thus MHM was, having checked it all out and sent the invoice to the patient, delighted to be told a few days later the client had received the £200 by BACS into her bank account.

    pete@medicalhealthcaremanagement.co.uk

     

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