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    • 26
      May
    • (0)
    • By Pete Crutchley


    • Medical Billing News

    Benefits v Fees

    The Difference

    This issue came up during a meeting with a consultant surgeon recently regarding the relationship between benefits and fees. More specifically how fees are accounted for against a benefits package and the possible creation of a shortfall.

    Consider the total benefits payable under a patient’s insurance policy. For example, the benefits payable may be £100. Obviously, it could be considerably more as will the possible fees mentioned below.

    To continue, however, against such a benefits package fees are deducted as follows:

    The patient attends for an initial consultation at a cost of £20. Therefore the £20 is paid out and the total benefits figure reduces to £80. Subsequently, the patient requires a surgical episode at a cost of £50. This too is paid out and the benefits accumulator, therefore, reduces to £30.  But of course, the hospital tenders their account (say £20) as does the gasman (£15). The benefits accumulator, therefore, further reduces to ZERO. Thus the benefits package is equal to the fees charged.

    However….

    If the initial consultation fee is £21, the surgical episode fee £51, the hospital account £21 and the gasman’s account £16 then the total fees total = £109 against a total available benefit package of £100.

    Thus, if when the fees are calculated against the benefits accumulator they exceed the total available a shortfall will be created.

    pete@medicalhealthcaremanagement.co.uk

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