# Deductibles/Co-insurance



## chavera (May 31, 2013)

Hello,

I work for a small family practice and we are wanting to start collecting from patients who have a high deductible and or a co-insurance amt. I am not sure where to begin since you don't really know how much the pt is going to be made responsible until after the claim is processed. If anyone has advice as to how to collect that would be great. Should we try collecting a set fee or should there be a scale created?


Thanks,

Raquel


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## mhstrauss (May 31, 2013)

chavera said:


> Hello,
> 
> I work for a small family practice and we are wanting to start collecting from patients who have a high deductible and or a co-insurance amt. I am not sure where to begin since you don't really know how much the pt is going to be made responsible until after the claim is processed. If anyone has advice as to how to collect that would be great. Should we try collecting a set fee or should there be a scale created?
> 
> ...



You should be able to get access to the fee schedule of any payer you are contracted with; that will tell you what the allowed amount for any CPT you bill will be.  Our PM software has a function that checks patient eligibility and benefits; that is how we find out how much of their deductible is remaining, what their co-ins/co-pay is.  Without knowing all this, it would be hard to collect the correct amount from each patient.


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## chavera (May 31, 2013)

So we would collect the allowed amt from the pt depending on what is done?

Thanks


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## mhstrauss (May 31, 2013)

chavera said:


> So we would collect the allowed amt from the pt depending on what is done?
> 
> Thanks



Correct.  That isn't always possible, since you don't necessarily know what the physician will do before the patient goes into the room, for example, what level of service, or whether or not any injections or anything like that will be done.  But you can get a protocol in place, such as estimating for a 99212 or 99213, then after the visit when the patient is checking out, make any adjustments based on what service was actually performed.  And if their plan is strictly copay for office visits, that definitely needs to be collected beforehand.  Verifying benefits prior to the appointment will allow you to see exactly what is expected, and that can cut down on collections attempts in the long run.  Well worth the effort it takes to get this rolling, if your office isn't already doing this.


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## suemt (May 31, 2013)

This is critically important for any new patients you are seeing.  I have seen where a patient with a high deductible plan knows darn well that they will have to pay out of pocket and they hop from one doctor to another never paying any of them.  Good luck chasing a new patient who just came to you the one time when they needed something.  

Sorry to sound so negative, but there are definitely patients who try to game the system and you have to be on the lookout for them.


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## hopepg (Jun 10, 2013)

Some insurance plan's  websites let you plug in the patient benefit info & get a determination of benefits. Take advantage of the different insurance websites. I also agree that you can obtain the fee schedules from the plans & calculate the benefits from the allowables. We do that also.


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