There are numerous occasions when a consultant can charge for follow-up consultation and a minor surgical episode.
But it is important to understand which private medical insurance companies will allow such a combination and which won’t.
Otherwise, you may well be missing out on a fee.
Take CCSD Code W9040 – an injection into soft tissue – as an example.
Insurance company A says a W9040 attracts a fee of £50 and will allow it to be charged alongside a £150 follow-up consultation.
Insurance Company B says a W9040 attracts a fee of £108. However, it will NOT allow it to be charged alongside a follow-up consultation.
So…
The total charge for W9040 with Insurance Company A = £200
The total charge for W9040 with Insurance Company B = £108
If the consultant surgeon does not realise Insurance Company A will allow a charge for the follow-up as well and only charge the W9040 fee of £50 they will immediately be £150 out of pocket.
Don’t expect the Insurance company to correct your error.
They won’t. Why should they? After all, it’s your job to ensure your invoices are correct. Nobody else.
Another example: CCSD Code S0820 – a curettage of lesions
Insurance Company A says an S0820 attracts a fee of £325 but will NOT allow it to be charged alongside a follow-up consultation
Insurance Company B says an S0820 attracts a fee of £107 and WILL allow it to be charged alongside a £150 follow-up consultation
So…
The total charge for S0820 with Insurance Company A = £325
The total charge for S0820 with Insurance Company B = £257
Once again, if the consultant surgeon does not charge Insurance Company B for the follow-up AND the episode he or she will immediately be £150 out of pocket.
To further complicate matters, and using the S0820 as the example, note that Insurance Company A set the fee for the S0820 only to be £325. Insurance Company B set the charge at £257.
If in error, the Consultant Surgeon charges Insurance Company A with £257 (insurance company B’s fee) then the consultant surgeon will undercharge and only be paid £257.
That is what they have asked for and that is what Insurance Company A will pay.
Thus it is vital if a consultant surgeon is to maximize the revenue generated by his practice that he understands at all times what he or she can and cannot charge for.
He or she must also understand fees can and do differ between insurance companies.
pete@medicalhealthcaremanagement.co.uk
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