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    • 29
      Nov
    • (0)
    • By PeteCrutchley


    • Medical Billing News

    How do I transfer a pre-auth TO or receive a pre-auth FROM a colleague?

    A question from a group of consultants who referred patients to each other and they had problems getting paid.

    Following a conversation with the insurance companies concerned the cause of the issue was clear.

    The consultants assumed that the pre-authorisation confirmed the patient could see any consultant. They were wrong.

     Specific consultant.

    A patient is referred normally to a specific consultant by their GP. Alternatively, of course, the patient may contact their insurance company. The insurance company might refer them to a specific consultant.

    In either case, a specific consultant is involved.

    If that consultant then refers the patient to a colleague, it is unsafe to assume the pre-authorisation will stand. It may not.

    What do you do?

    In a perfect world, the patient will contact their insurance company and ask if the pre-authorisation can be transferred.

    Normally this is not a problem.

    But what do you do when the patient hasn’t done so?

    You need to speak to the insurance company concerned and explain why the pre-authorization should be transferred.

    In other words, the insurance company up to the point they are told of a second consultant is unaware of his involvement. When the insurance company receives an invoice from a different consultant, they are confused. They will either delay payment or worse decline the invoice.

    If this happens you will have no choice but to sort it anyway.

    Be pro-active

    If you do need to refer a patient to a colleague or a patient has been referred to you by a colleague make sure the patient’s insurance company is aware.

    On the occasion(s) I’ve had to do this, either a new pre-authorisation has been issued or an amendment to the existing pre-authorisation made.

    Insurance companies are NOT the enemy. They will help if they can.

    It is unreasonable though to expect them just to pay out if they receive it from a different consultant to the one expected.

    You can transfer have a pre-authorisation transferred to a colleague but speak to the patient’s insurance company first, please.

    pete@medicalhealthcaremanagement.co.uk

     

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