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    • 13
      Nov
    • (0)
    • By Pete Crutchley


    • Medical Billing News

    Open Referral – it’s just not right

    Recently a family member in conjunction with her GP decided an appointment with a private consultant was necessary.

    As the family member had private medical insurance through her employer, a phone call was made to the consultant suggested by the GP. It turned out although not an MHM client, the consultant practice manager and I are old friends. So  I made the call myself and booked the appointment.

    Open Referral

    Came as a surprise the next day, for my family member to announce the insurance company had called. They wanted her to see a different consultant. My family member quizzed them for an explanation. Eventually, she was told the second consultant didn’t charge as much as the one she wanted to see. Not a good thing to say. My family member insisted – and had to seriously insist at that – in seeing the consultation of her choice. I quickly found out how much the second consultant charged for an initial appointment. It was indeed less.

    The Consultant’s fee

    Nonetheless, the appointment with the first choice consultant happened and the medical issue resolved.

    Two weeks later a letter arrived from my family member’s insurance company stating the consultant had been paid. However,  there was a shortfall as the 1st consultant’s fee was higher than that of the second consultant and my family member was required to pay the difference.

    The fact that my practice manager friend is pulling her hair out at the moment with the increases in shortfalls she’s seen this year whilst relevant, is not the point.

    Fee levels

    The point and the stark reality is that the insurance company were using finance as criteria upon which to base the decision which consultant one of their policyholders (my family member) went to see.

    And that, I’m sorry, is NOT right.

     

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