A pre-authorisation can be backdated.
In the majority of cases, your patient will obtain authorisation for a consultation in advance of the actual date. But sometimes, the patient arrives for the consultation and hasn’t obtained the pre-authorisation. First question: should you see the patient?
Yes. The patient care must come first.
But what do you do if the patient does not have a pre-authorisation? In the real world it does happen. How should your practice handle it? Ask the patient to ring his/her insurance company and obtain the pre-authorisation. But….
If say the consultation was on February 8th and the patient does not call the insurance company until February 15th, the patient must make sure the insurance company know when the consultation took place. In this example, the patient did not tell the insurance company it was a week earlier. 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. In which case an invoice for the initial consultation should be sent to your patient.
This is not the insurance companies being unreasonable.
If you think about it, the patient has incurred a potential liability on behalf of the insurance company. The insurance company knows nothing about. Ultimately the patient is liable for the consultation fee of course thus the invoice is sent to the patient. The patient rings up (normally quite upset). They point out they are insured and are indeed covered for consultations in their view.
Numerous phone calls between the patient and the insurance company and the issue will be finally resolved. The invoice is submitted to the insurance company and its paid in full. This time it was anyway.
It would have been paid a lot quicker IF the patient had been asked to advise their insurance company the consultation was for a specific date. When the patient arrives for the consultation it is then simply a matter of confirming with the patient, the correct authorisation numbers have been obtained.
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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