Many times either the patient or the consultant has queried why an account has not been paid in full. The cry is heard citing a correct pre-authorisation has been obtained.
The issue concerns the interpretation of the phase “pre-authorisation” and what it really means.
Pre-authorisation confirms that the patient has a policy with a private medical insurance company. Such a policy is, however, subject to the terms and conditions of the policy. In other words, it does NOT guarantee full payment.
For example, there may be an excess of £250 on the policy or there may be a benefit cap on the policy.
This is only right and proper if you consider the issue from the viewpoint of a medical insurance provider.
What is clear is that over the last few years, patients or their employers have sought to reduce the cost of medical insurance. They have done so by agreeing to a higher excess or a cap on total benefits paid out.
It is not the only reason but it is this, which has caused the increase in deductions i.e. excess and shortfalls. Nor is it a reluctance by private medical insurance providers to cover the full cost of treatment.
Yet still, “but it was pre-authorised” is stated as the reason why the patient believes he/she should not be liable for any amounts outstanding.
For confirmation of the true meaning of “pre-authorisation” call any of the big 5 private medical insurance companies. Whilst on hold you will hear the message to the effect – “pre-authorisation confirms the patient has a policy subject to the terms and conditions of the policy”
Pre-authorisation does not guarantee full payment. Neither will it stop deductions for excess or shortfalls.
pete@medicalhealthcaremanagement.co.uk
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