The patient arrives for the consultation but hasn’t obtained a pre-authorisation from his/her insurance company. First question: should you see the patient? Yes of course you should. Patient care comes first.
But the patient does not have a pre-authorisation. It does happen. It shouldn’t but in the real world it does. How should this be handled? The patient should ring his/her insurance company and obtain the pre-authorisation a soon as they possibly can. But….
And this actually happened. If say the consultation was on September 3rd and the patient calls the insurance company on September 5th, the patient should make sure the insurance company know when the consultation took place. In this example, the patient did not tell the insurance company it was two days earlier and thus when MHM tried to invoice it was declined as the consultation was before the date upon which the pre-authorisation was issued.
If the patient holds an insurance policy, which will not allow the backdating of a pre-authorisation you’ll have even more difficulties.
This is not the insurance companies being unreasonable. If you think about it, the patient has incurred a liability on behalf of the insurance company, which the insurance company knows nothing about. Ultimately the patient is liable for the consultation fee of course so an invoice is sent to the patient. The patient rings up (normally quite upset) and points out they are insured and are indeed covered for consultations in their view. Numerous phone calls between the patient, the insurance company and the outsourced billing company later, the issue is finally resolved. The invoice is submitted to the insurance company and its paid in full.
It would have been paid a lot quicker and without the hassle IF the patient had been asked by the consultant to advise their insurance company the consultation was for a specific date.
If this is happening to you, it’s an issue that should be addressed and prevented otherwise you may spend 15 – 30 mins just sorting this one small problem out!
pete@medicalhealthcaremanagement.co.uk
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