Wiki 2018 Deductibles- PCP Office

[Tshady]

Please advise! We're seriously considering adopting a policy of charging our patients, that have commercial insurance with high deductibles and no co-pay, a $50 fee to apply towards their unpaid deductible and bill them for the remainder. We totally understand that certain visits such as preventative, labs, etc do not apply to the patient's deductible and we can verify in advance the accumulation amount that the patient has met towards their deductible. I know that OB/GYN's have patient's pay their deductibles up front towards labor and delivery and surgeons charge the patient's their unpaid deductibles before having surgery. Is anyone else doing this? Give me your thoughts.......

 

[MonarchMedBill]

E/M visits?

Please advise! We're seriously considering adopting a policy of charging our patients, that have commercial insurance with high deductibles and no co-pay, a $50 fee to apply towards their unpaid deductible and bill them for the remainder. We totally understand that certain visits such as preventative, labs, etc do not apply to the patient's deductible and we can verify in advance the accumulation amount that the patient has met towards their deductible. I know that OB/GYN's have patient's pay their deductibles up front towards labor and delivery and surgeons charge the patient's their unpaid deductibles before having surgery. Is anyone else doing this? Give me your thoughts.......

I don't believe I've seen a policy against this practice from commercial payers, in fact, many physicians are starting to collect deductibles up front. I would suggest creating a form with fill-in-the-blanks so that you can change the amounts for each patient. While $50 may sound like a good round number, if you do a procedure with a high reimbursement, you may want to collect a higher pre-paid amount. You can also use the form to verify insurance eligibility and deductibles.

 

[aamedee92]

We charge minimum of $50 at check-out for patient's with deductibles no matter what was done in the room.

 

[johnmeyer]

At my practice, we collect deductibles, co pays, and co insurances based on our allowable for the various payers versus something like a fixed co pay. We use a program with Navicure payments that is able to estimate the amount due based on the patient's insurance (allowable and benefits at time of service). It's a nice tool to have because you can either print out a "statement" of services provided or expected to provide with the allowable amounts and amounts that the patient is responsible for or you can email it to them and it is HIPAA compliant because they have to log in using their email address, date of birth, and zip code. I always tell them, "the estimated charge for today's visit is...." since it's obvious that most people will hold you to the amount you collect and think they will owe nothing else. Of course, this also makes collecting deductibles and co insurances for E&M services tricky since I'm collecting as a patient is checking out and generally unable to accurately determine what level to code. That's another reason why I always tell them the estimated charge is....

Besides, I know there are other practices in my area doing this as I go to call them for what ever reason and their answering services comes up with, "Please be aware that co pays, deductibles, and co insurance are all due at time of service."

And yes... I have had people that have argued that they should be billed and that we cannot collect up front. I had one that tried that with me saying we are not allowed to collect up front because she's an insurance agent that works with one of the major health insurance companies and knows we can't do that.

Now I will say that not all insurances will allow collections up front. I've ran across at least one (I think it was an Aetna plan) that stated in the description of benefits that I ran on Availity that no provider is allowed to collect upfront and that we have to bill the insurance, then balance bill the patient. Other than that, I'm not aware of any issues collecting up front so long as it's no more than the allowable for the payer.