Consider when the patient has contacted his/her insurance company and been issued with a pre-authorisation number. The actual meaning and use of a pre-authorisation was discussed yesterday.
A pre-authorisation does not mean, the insurance company will accept your charge.
This happened to the MHM client – a gynaecologist – mentioned recently. We spoke to the insurance company concerned who advised whilst they did indeed issue a pre-auth, this did not mean they would accept the charge. In this example, pre-authorisation had been refused. Yet again the message came through loud and clear:
Pre-authorisation is not a guarantee of payment.
No argument from me on that one. It has always been so. My issue though is why did the insurance company issue a “DECLINED” pre-authorisation? If they were not prepared to issue a pre-authorisation then they should not have issued one at all. There is NO WAY I’d be able to tell if the pre-authorisation was acceptable or not.
This point was duly made to the insurance company who were not able to consider the comment. They had always done it that way. I have the utmost respect for private medical insurance companies most of whom are extremely efficient and willing to help. Whilst I’ve had numerous disagreements with all of them regarding fees or associated issues, never have they implied or stood behind the “we’ve always done it that way” position.
But on this occasion, it feels very much like a case of stop wasting your breath!
pete@medicalhealthcaremanagement.co.uk
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