Sometimes it can be confusing as to the precise reasons an invoice is declined by an insurance company.
For example: an invoice for an initial consultation and an investigatory procedure was declined recently. We were expecting a £200 fee for the consultation and a £75 for the procedure i.e. £275 (figures are fictitious; for illustration purposes only)
Instead payment was made for the procedure only i.e £75. Thus the phone call to the insurance company concerned.
It was NOT as the consultant surgeon thought because the insurance company had decreed a consultation fee could no longer be charged at the same time as the procedure. Nor was it as stated on the remittance from the insurance company that the episode was within 6 months of a previous treatment date.
It was because the patient’s policy did not cover them for any type of consultation – initial or follow up. There are a number of policies out there with this stipulation and, other than asking the patient, they cannot be identified until payment is made by correspondence received from the insurance company.
In any event the £200 consultation fee was the patient’s liability. To a large extent the reasons for the shortfall were irrelevant. What was and is much more relevant is that the issue was identified and actioned quickly. Shortfalls / excess, if they are not actioned quickly, will build up and represent a substantial problem for any private medical consultant. When MHM are contacted by a consultant surgeon and asked to review the process and report on the performance of a practice, shortfalls / excess are consistently in the top three problems he/she is facing.
Thus MHM were, having checked it all out and sent the patient liability invoice to the patient, delighted to be told a few days later the client had received the £200 for the initial consultation by BACS into her bank account.