Charged above scheme rate
The scheme says the provider charged more than the rate it pays, and it funded its rate only.
Words you might see
- “above the scheme tariff”
- “scale of benefits”
- “100% of the scheme rate”
Questions to ask
- What rate did the scheme pay for this service, and how is that rate determined?
- Is the treating provider party to a payment arrangement with the scheme, and on what terms?
- Does the scheme fund the full cost where the service is a Prescribed Minimum Benefit obtained from a designated provider?
- Please provide the tariff or scale of benefits the scheme applied to this claim.
Details to have ready
- What your provider actually charged, from their own account.
- Whether you were told before the service what the provider would charge.
Pryse is not a law firm and does not act for you. Nothing here is a determination of your rights or legal advice, and no registered scheme rule is quoted. The questions ask your scheme to provide its own.