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.
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.
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.
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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