This particular blog is NOT concerned with the general question of an uplift of all fees. Nor does it relate to the question of if fees (outpatient or surgical) are high enough or not.
This blog is concerned with how you request a fee uplift. It assumes, for example, that as a private consultant surgeon you wish on a specific case basis to uplift your fee.
For example. Very recently an MHM client (his/her specialism is not relevant) found himself in the position of having to do more in theatre for the patient than he anticipated. Indeed the surgery took almost twice as long. The immediate reaction of a surgeon in such a situation might be to simply double the fee eg £500 standard fee but surgery took twice as long therefore fee should now be £1,000. So send an invoice to the insurance company for £1,000
But it absolutely is NOT as simple as that.
Almost certainly the insurance company will NOT pay the invoice. If lucky the surgeon may get paid £500; most likely the insurance company will call and ask why the increase. Even after a conversation however they won’t just pay the £1,000 invoice.
The correct way to increase a fee is BEFORE the invoice is raised, contact the insurance company and advise you will be submitting a request for a fee uplift. The insurance company will require a justification from the surgeon as to why he/she feels the fee should be uplifted. In other words they will require sight of, for example, theatre notes. A letter from the surgeon explaining why the procedure was more complicated than normal helps too.
Only then should the invoice be submitted. In other words when the insurance company receive the invoice they have already been told WHY the invoice is for a higher value than normal. They can also see a rational and reasonable reason why the request has been made. This does not mean they will accept it. It does mean the request will be considered from a more favourable position.
But don’t just double the fee if the surgical episode took twice as long even if you have followed the MHM recommended course of action.
In the case of the MHM client referred to earlier, we contacted the insurance company on his behalf. We requested a 50% uplift in fee and advised full correspondence in support of the request was en route to them too. Only then did we submit the invoice (electronically as it happens)
The happy result was later that month (May 2015 in fact) we were advised the uplift fee had been approved and our client would receive full payment.
Instead of £1,025 he received £1,537.50
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