The reality is, the question itself is incorrectly asked!
In the case of a private medical insurance company, a consultant surgeon or other medical professional doesn’t set his/her own fees.
Instead the fees payable are designated by the private medical insurance company with whom the patient is insured.
Take ANY surgical episode (or consultation for that matter) and you’ll discover the fee payable by one insurance company will differ between that set by a second insurance company even though the same episode takes place. So it’s the insurance company that sets the fee and the fee can differ between them.
Taking the above example further using a fictitious CCSD code of XX4321, insurance company A may set the fee at £100, insurance company B set the fee at £125 and insurance company C at £150. Across them there is a difference of £50.
The problem arises when the consultant makes a mistake and bills insurance company C with the £100 set by insurance company A, and immediately looses £50.
That said, if insurance company A is billed insurance Company C’s £150, immediately the consultant is shortfalled. The suggested (and WRONG) solution is to pass the shortfall to the patient. By all means do so up to the point, insurance company A realise what is being done. Keep doing it and your recognition will be at serious risk!
Yet consistently many consultants complain that the fee is too low (which it probably is) but don’t realise it is because they are charging £100 when the insurance company concerned will happily pay £150.
Note we are talking about fees payable by a private medical insurance company.
We are NOT talking about fees that are payable by a self-funding patient!
How do you manage such a situation and set your fees?
You don’t.
You employ an out-source company to make sure you are invoicing the right fee in the first place!
pete@medicalhealthcaremanagement.co.uk
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