The patient arrives for the consultation. He hasn’t obtained a pre-authorisation.
Yes, of course, you should. Patient care must come first.
But the patient does not have a pre-authorisation! It does happen. It shouldn’t but it does.
How should this be handled? Ask the patient to immediately ring their insurance company.
Say the consultation was on Friday, January 24th and the patient calls the insurance company on Monday, January 27th.
The patient should make sure the insurance company knows when it took place.
In this example, the patient did not tell the insurance company it was Friday before.
When MHM tried to invoice, it was declined.
The consultation was before the date upon which the pre-authorisation was issued.
If the patient holds an insurance policy, which will not allow the backdating you’ll have even more difficulties.
This is not the insurance companies being unreasonable.
The patient has incurred liability on behalf of the insurance company yet the insurance company knows nothing about it.
Ultimately the patient is liable for the consultation fee of course so an invoice is sent to the patient.
The patient rings up (normally quite upset) and points out they are insured and are covered for consultations.
Numerous phone calls between the patient, the insurance company later, the issue is finally resolved.
The invoice is submitted to the insurance company and its paid in full.
It would have been paid without the hassle IF the patient had been asked by the consultant to tell their insurance company when the consultation was for.
If this is happening to you, it’s an issue you can address. Otherwise, you may spend 15 – 30 mins just sorting this out!!