Wiki Pt deductible

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ortho1991

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Hi All, I work for a large ortho group in MA and we are finding more and more insurances plans have high deductible.
Does anyone have information or experience collecting at least part of the de. upfront?

Any information re this would be appreciated.

Thank you Cathy
 
Cathy, do you know what your contracted rate is with each carrier? We have the contracted rates programmed into our billing software. When a patient with a high deductible comes in, we know what each service will cost her. And many of these high deductibles are associated with an HSA account. Most patients pay day of with their HSA debit/credit cards.
 
My input is similar to pattiland. Check contracts with the various payers but also check with the payer how much of the patient's deductible has already been met. Then base your pre-payment/up-front collection on those factors.

Another thing to consider, since ortho practices tend to have a lot of recurring patients look into checking these patient's balances when they return to the clinic & ask the patient to pay on their balance. In my opinion, asking for payment on account balances when the patient is there in front of you is much easier (& possible less costly) than sending statement after statement.
 
yes checking the patients insurance before each visit and then how much of their deductible has already been met is the best way if you plan to charge the patient up front but gosh that is a lot of work.

We are out of network PCP's so almost all of our patients have large deductibles. The problem with taking the money up front is what if the insurance company tells you they still have "X" amount of dollars left to apply to the deductible and say they recently went to another practice that has not submitted their bill yet. The deductible will go to whatever practice gets their claim in first. If you accept the deductible for the patient and it gets applied to the other practice then you have to reimburse the patient.

We have found that having a patient sign something up front stating they are aware of their deductible and what the charges could be is a huge help.
 
cathy56 said:
Hi All, I work for a large ortho group in MA and we are finding more and more insurances plans have high deductible.
Does anyone have information or experience collecting at least part of the de. upfront?

Any information re this would be appreciated.

Thank you Cathy
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Do it for procedures, as opposed to office visits. I highly recommend it, as that is where your big money is and deductibles these days are well into the thousands. We notify the patient about a week in advance and then check again the day before, so if additional deductible has been met, we collect less on the day of the procedure.
 
This is just my opinion as a former practice owner. For cash flow purposes, it is much better to collect all copays and or deductibles up front when the patient is in the office. It also significantly reduces the expense involved in billing the patient and then hoping they actually pay you. If claims from various offices happen to cross and you have to partially refund some of the up front money you collected from the patient, that's much better and easier than trying to collect through billing them.

As copays and deductibles started to rise significantly over the last few years, we found that many patients wouldn't pay them when billed. Some had the attitude that our office should absorb the cost of their deductibles and copays because we all know that all health care providers are millionaires and their office overhead never rises and since the insurance companies keep raising their premiums that means our fee payments keep increasing also right?

Also, frankly, many patients have no clue what their deductible is and think that since they're paying hundreds of dollars every month for their insurance that they have coverage from dollar one of expenses. How many times have all of us heard the words, when we try to collect a copay or deductible, "But I have insurance."

Tom Cheezum, O.D., CPC
 
Yes, may sound like a lot of work..but when that extra works potentially helps to increase the cash flow for the practice, its worth it.

Cash flow is always important but I think even more so in the last few years since so many payers now process zero payments to the providers, because of deductibles.

Maybe explain to the patient that what you are asking for as a pre-payment is estimated based on today's benefit verification from their insurance. Advise them that they may be responsible for more OR less depending on how the payer processes the claim.

Let them know if less, a refund for that overpayment will be reviewed to be issued. Then I would suggest to let them know about your refund policy (whatever that may be for your practice).

I have dealt with a few patients who assumed that they would be refunded what they overpaid for a surgery on a specific DOS. But, those same patients have other encounters with the practice that may still have patient balances due. I let them know that any of their potential overpayment for the specific surgery DOS may then be applied to their patient balances on other dates of service (clinic visits, etc...).

Just some suggestions. Good luck!
 
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