I’m used to insurance companies declining to pay a consultation that occurs within 10 days of a surgical episode. It’s the very reason before I invoice consultations within 10 days of treatment, the surgeon is contacted and asked if the consultation was “routine” or there were additional medical requirements.
If routine, then he simply won’t get paid.
If on the other hand there were medical reasons, he may well.
Its always best to call the insurance company and provide evidence to them as to WHY the consultation was necessary in such a situation. Then the consultant will normally get paid. After all the insurance company is NOT the enemy.
But what does throw me completely is when an initial consultation is declined because:
“Under the patient’s policy benefit is only payable when treatment is related to an eligible in-patient or day-patient stay within six months. Outstanding treatment costs are, therefore, due from your patient.”
How can an initial consultation be refused under such conditions? An initial consultation don’t forget.
What I’m actually being told is that the consultation is not covered under the terms of the patient’s policy. That is completely different. I did suggest to the insurance company concerned it amended the wording to read: “initial consultations are not covered under your patient’s scheme”
Either way however, the surgeon has a declined invoice to deal with and must act accordingly.