A group of consultants who referred patients to each other asked this question. They always seemed to have problems getting paid. The cause of the issue became clear following a conversation with the insurance companies concerned.
The consultants were assuming the pre-authorisation confirmed the patient could see any consultant.
This is not the case.
A patient is normally referred to a specific consultant. Alternatively, the patient may contact the insurance company. 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, it is unsafe to assume the pre-authorisation for the second consultant will stand. It may not.
In a perfect world the patient should have already contacted their insurance company. They should have asked if the pre-authorisation can be transferred. Normally this is not a problem. But what do you do when the patient hasn’t contacted their insurance company? What do you do if you now wish to invoice.
The only thing to do is to speak to the insurance company concerned. 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 even not pay it.
If this happens you have no choice but to sort it out anyway.
It makes much more sense 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. In some cases, an amendment to the existing pre-authorisation has been made
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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