What on earth is that?
A couple of recent examples where consultants have tried to base their fees on the best rate available. Take the consultant who realises that insurance company Num 1 pay £300 for a procedure whereas PMI company 2 pay £400. He, therefore, decrees he will charge PMI Company 1 the higher PMI Company 2 rate each time he performs that procedure.
He, therefore, decrees he will charge PMI Company 1 the higher PMI Company 2 rate.
Great idea. Right up to the point PMI company 1 who the patient is actually insured with receives the invoice. They will decline to pay that fee. Most likely they will shortfall it. But, replies the Consultant, no problem because the patient is ultimately liable for any shortfall.
I know of one consultant who even puts on his website “we use PMI Company 2 rates to calculate our fees. If there is a shortfall you will have to pay it”
Yes, the patient is liable for a shortfall. But not when the consultant is fee assured.
Most likely a letter addressed to the Consultant from PMI Company 1 will arrive if he does not stop inappropriately billing. It will point out that what he is doing is not acceptable; carry on doing it and recognition is at risk.
It’s incredibly similar to unbundling. Continue doing it over a number of months and for sure eyebrows will be raised. Even if there is no “fee assured” status PMI Company 1 will be well aware of regular and consistent charges that are in excess of their published fee schedule.
Notwithstanding the above, of course, consultants want the best possible fee for a procedure but attempting to obtain same by “inappropriate billing” is not the smartest way to go about it.
pete@medicalhealthcaremanagement.co.uk
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