WHAT IS A SHORTFALL?
Shortfalls are only an issue for patients who are using health insurance to fund a medical treatment. A shortfall arises when there is a difference between our fee, and the level of cover offered to you by your health insurer. When a shortfall occurs, your health insurer may elect to pass this on to you to pay directly to Bath Pain Management. In this situation you will have a legal obligation to pay the shortfall yourself.
WHY DO SHORTFALLS OCCUR?
For many years, many health insurance companies have not raised their benefit levels payable in respect of medical fees in line with inflation. In some cases, they have not significantly raised their benefits for 10 years or more. Although Bath Pain Management have elected to raise their fees by below-inflation levels, nevertheless a gap has opened up between the benefits payable to patients by their insurers and our fees.
WILL I HAVE TO PAY A SHORTFALL?
Not at all. Many insurers have increased their benefits in line with inflation, and will settle our fees in full. Depending on your particular policy or relationship with your insurer, even if there is a shortfall, the insurer may elect to settle our fee and not pass the shortfall on to you.
HOW WILL I KNOW?
The only way to be sure is to discuss any proposed treatment with your insurer prior to having any treatment performed. We endeavour to be completely transparent with respect to our fees. We will give you a code for your treatment and an estimated fee. Alternatively, you can find the total medical fee for your treatment by using our fee estimator. A shortfall will be the difference between this fee and the level of benefit payable by your insurer. Your insurer will tell you if they are limiting your benefit and if there is a shortfall to pay, and what the level of that shortfall will be.
HOW DO I PAY FOR A SHORTFALL?
If there is a shortfall to pay we will contact you after your treatment. Please note that this may not be until some weeks after your treatment, as it can take a significant time for health insurers to settle their accounts with us, and only at that stage will we know if there is a shortfall for you to pay.
If you have any questions about your fee or any potential for a shortfall please contact us before your treatment.