An MHM client recently performed a certain surgical episode. The surgery was something he’d done many, many times before with invoices being sent and paid.
Pretty standard in other words.
One particular insurance company paid £300 for the procedure. Before sending the invoice I’d checked per normal this was the correct fee.
It was.
When the payment remittance arrived from the insurance company I was, therefore, most puzzled to see the fee had been reduced to £240.
It was not a shortfall. It was not excess. Therefore any shortfall could not be passed on the patient.
According to the remittance supplied by the insurance company, the fee of £240 was in line with the normal published fees.
Except according to the insurance company’s own website, it wasn’t.
So I called the insurance company and asked them to explain.
The reply was wonderful. The fee had obviously been reduced between the date I had invoiced and today.
I have a view on that argument and it is not a positive one.
However, as I pointed out, my client had performed the same surgical episode on different patients both before and AFTER this one. A fee of £300 had been paid in all cases.
Also, I have more than ONE client who, as it happens, perform the same procedure although in different parts of the UK and been paid £300 since the date of this episode as well.
Still not to be beaten, the insurance company suggested the specific consultant surgeon I was dealing with as regards this case had agreed, as part of his updated recognition process, to accept a lower fee i.e. £240. That came as complete news to me! It came as a shock to the Consultant Surgeon too!
So I called the insurance company back save this time I asked for my normal contact there.
After the normal pleasantries, I explained my predicament.
The phone went quiet for a while but then my contact came back on the line with the immortal “Oops – we got that one wrong”
It’s a good job I was paying attention.
I really did have to smile.
pete@medicalhealthcaremanagement.co.uk
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