A group of consultants recently asked this question. They always seemed to have problems getting paid. The cause of the issue became clear following a conversation with the various insurance companies concerned.
The consultants were assuming the pre-authorisation confirmed the patient could see any consultant with the group.
This is not the case.
A patient is normally referred to a specific consultant by their GP. Alternatively, the patient may contact their insurance company and the insurance company refers them to a specific consultant. In either case, a specific consultant is involved.
If the consultant then refers that patient on to a colleague for whatsoever reason, it is unsafe to assume the pre-authorisation for the second consultant will stand. It may not.
The patient, ideally, should have already contacted their insurance company. They should have asked if the pre-authorisation can be transferred to the second consultant. This is not a problem normally. But what do you do when the patient hasn’t contacted their insurance company? Should you now wish to raise an invoice, what should you do?
The sensible thing to do is to speak to the insurance company concerned and explain the problem. The insurance company up to the point they are notified of the appearance of a second consultant is blissfully unaware of his/her involvement. So when they receive an invoice from a different consultant than stated, they are confused. They could either delay payment of the invoice or worse and very easily decline the invoice.
You have no choice if this happens to you but to sort it out.
It makes much more sense therefore if you do need to refer a patient to a colleague to make sure the patient’s insurance company is aware. On the occasion(s) I’ve had to do this, it has resulted in the issue of a new pre-authorisation against the second consultant. An amendment to the existing pre-authorisation has been made in some cases.
Insurance companies are NOT, as I’ve said before, the enemy.
It is unreasonable to expect them just to pay an invoice from a consultant if they receive it from a completely different consultant to the one they expected.
You can transfer have a pre-authorisation transferred to a colleague. Speak to the patient’s insurance company first, however.
pete@medicalhealthcaremanagement.co.uk
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