I’m used to insurance companies declining to pay a consultation charge submitted on behalf of an Orthopaedic Surgeon that occurs within 10 days of a surgical episode.
The reality however is that this does not impact solely on Orthopods.
I’ve seen it happen with GI Surgeons as well as ENT. It’s the very reason before I invoice consultations within 10 days of treatment, irrespective of the specialism, the surgeon is contacted and asked if the consultation was “routine” or if there were additional medical requirements. Its easy to tell when the patient had their surgery. It should have been invoiced by now and a quick look at the sales ledger will confirm if it has. But its’ only the consultant surgeon who knows why the consultation took place within 10 days.
If routine and the post surgical follow up consultation is within 10 days of the surgical episode, then you won’t get paid.
If on the other hand there were medical reasons, then it is possible for the invoice to be submitted. But how?
Its always best to call the insurance company and advise you will be submitting the invoice. Then provide evidence to them as to WHY the consultation was necessary. Nine out of then times the consultant will then get paid. After all the insurance company is NOT the enemy.
But what does throw me completely is when it is an initial consultation that has been 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?
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”
It’s particularly annoying when this happens because you have to speak to the insurance company concerned and ask precisely why the consultation was declined. I have no problem with making such calls. Where I have the problem is being placed on hold waiting my turn to ask a question that would not be necessary if the insurance company had made it clear WHY the consultation was declined. If the reasons for decline had been made clear. I would not have to make the call, not had to wait my turn.
In the time I’ve taken to resolve the query I could have called the patient and obtained payment for the declined consultation for one thing.