Wiki Deductibles - Billing

[Sheri1997]

With the new healthcare reform, I am seeing more and more of the diagnostic tests that we perform in our office, being applied to patients deductibles.

My office staff tries to the inform the patient of this potentially happening so that they are not shocked when they receive a bill. Eighty percent of the time, we call the insurance company and ask if the procedure will be applied to the deductible just so we know, but I still have patients that think it is our responsibility to tell them exactly what will be owed and are surprised when they have a substantial balance after the insurance claim has processed and "paid".

I am interested in other practices protocols for informing patients of potentially large balances. Thank you for your insights.

 

[kbearden1985]

I used to work in our facility's Precertification Department. Along with obtaining precerts, it is also that department's responsibility to obtain benefits for the applicable procedure and figure an estimate for the patient. Patients are contacted prior to their date of service and made well aware that the price they're being given is only an estimate, and when they come in for the procedure they are required to sign a letter stating that they understand such. That letter is scanned into the patient's record. This process seems to work well for our facility. Yes, you occasionally have patients call and complain about what they end up owing, but once you remind them of what they were told prior to their service and ultimately the letter that they signed stating they understood, they don't say much after that.

 

[stacilee]

I work with this on a daily basis, we call the insurance company and get an estimate from the insurance company and then we let the patient know before they go for the test roughly how much they will have to pay out of pocket.

 

[cldavenport]

Along with informing the patient of their estimated out of pocket cost, you can also inform them of any type of payment plan your office has in place. (provided that your office has one). Sometimes this will "soften the blow" when informing patients of the amount they will be responsible for. Some patients may not be aware of such programs and/or they just won't ask.