I’m used to insurance companies declining to pay a consultation charge for an Orthopaedic Surgeon within 10 days of surgery.
The reality is that this does not impact only on Orthopods.
I’ve seen it happen with GI Surgeons. And I’ve seen it with ENT clients.
It’s the very reason before I invoice consultations within 10 days of treatment, I ask if the consultation was “routine”. Or if there were additional medical reasons.
But it is only the consultant surgeon who knows why the consultation took place.
If routine, a post-surgical follow-up within 10 days, might not get paid.
If on the other hand there were medical reasons, then it is possible.
But how?
Call the insurance company and provide evidence on WHY the consultation was necessary.
Nine out of ten times you will get paid.
The insurance company is NOT the enemy.
But what does throw me is when it is an initial consultation that has been declined because:
“Under the patient’s policy benefit is only payable when treatment is related to an eligible in-patient or day-patient stay within six months.”
How can an initial consultation be refused under such conditions?
It can’t.
What I’m actually being told is the consultation is not covered under the terms of the policy.
That is different.
I did suggest to the insurance company it amended the wording to read: “initial consultations are not covered under your patient’s scheme”
Where I have the problem is asking an unnecessary question. If the insurance company had made it clear WHY the consultation was declined there is no reason to call.
In the time I’ve taken to resolve the query I could have called the patient and I could have obtained payment for the declined consultation for one thing.
pete@medicalhealthcaremanagement.co.uk
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