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diabolical high deductible plans

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  • diabolical high deductible plans

    Is everyone else getting more and more high deductible commercial insurance plans that shift the total cost of the patient visits to the patient?   We have some commercial insurers that depend on us billing the patient for the entire office visit.  The patient balks at paying 200 dollars for the 30 minute initial visit, doesn't pay, doesn't show up again, and we get nothing for the visit.    The insurance company gets off without having to pay anything for the visit because it tells us to collect from the patient who doesn't show up again.  We don't use a collection agency as most of our patients are not very well off so I suspect that our yield would be low.   These high copay plans are a great way for insurance companies to limit patient office visits and avoid paying for office visits.

  • #2
    If someone walked out on a $200 bar bill or restaurant tab, the establishment would call the cops. Absolutely send this to collections. Better still, if you aren’t in an emergency room, don’t send the patient back from the reception room until he or she pays the patient’s expected share of the cost of treatment.

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    • #3
      thats the tricky part about these new plans.   They only kick in after the patient meets a certain deductible so that we only know after the patient has been seen that they are responsible for the entire bill.   After we submit the bill to insurance, it tells us the patient is responsible for the whole bill.

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      • #4
        The costs are certainly ridiculous. I pay over $1100 a month for my families high deductible health plan. My wife went to the ER with a kidney stone and it cost $2600 for our portion ($7500 billed). Insurance paid $0 and that doesn’t include physician or radiologist bill. Had to have surgery a week ago and they estimated our portion a little over 4K for the hospital part. They try to get you to pay before you have surgery or even leave the ER.

        I have a 6k deductible and 8k OOP max. I’ve paid the ER bill, but waiting for surgical bill to go through insurance as we should hit our OOP max.

        Crazy that I pay so much and it covers so little.

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        • #5
          You need a system that verifies their remaining deductible at the time of the visit. Get a credit card on file. Have them sign a form indicating it will be charged for the balance if no payment is received. On check out collect the predicted total based on a billing sheet. Refuse to pay or leave without paying? Submit bill and if they haven’t paid charge the card based on the EOB.

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          • #6
            It's actually very clever, I'm not sure why the insurance companies didn't think of it before.  I can have an insurance plan that costs $10,000 per year, but covers everything with no copay to the patient, or I can have a plan that costs $8,000 per year, that only pays out when the patient pays for the first $2,000 of costs.   The out of pocket expense to the patient is actually the same ($10,000), but the behaviors on the two plans are vastly different- the patient with the $2,000 deductible avoids office visits, er visits, medications because they do not have $2,000 in their bank account, the providers more frequently do not get paid when the patients do not pay, and the insurance company keeps most of the money.   There is actually very little incentive for a private commercial insurance plan to keep their members "healthy", I remember reading or hearing that on average, patients change their insurance plans every 3-5 years, far too short of of in interval for any benefits of better blood pressure or diabetic control to have any cost savings to the company.    Specialists like myself get on the wrong side of patients as patients do not see the value we are providing in their care to justify the cost.

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            • #7
              Medicine is a business. You need to collect payment either up front or at the completion of the visit.

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              • #8
                One simple procedural change. Payment at the desk BEFORE restraints come off.
                https://www.vitalitymedical.com/posey-twice-as-toughandtrade-hobble.html
                Protocol , doctors orders. Universal keys are available.
                By no means is that offensive. If a patient objects, booting the vehicle works well too.
                Seriously, you don’t need patients that generate zero collections.
                At a minimum post a sign, “payment due upon complyof visit”. Or use restraints.

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                • #9
                  You should be able to call the insurance and get an estimated patient portion.

                   

                  Whether you can do this and maintain a flow of patients is a whole different story.

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                  • #10
                    When patient checks in at the front, "how would you like to pay for your visit today? "

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                    • #11
                      some places charge and collect their negotiated fee up front; any refund due to having met a deductible will be provided later. It will turn some people off and maybe they’ll leave your practice or not come in the first place, which could be a good thing. most who intend to pay their bills should have an understanding of why it has to be that way.

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                      • #12
                        That is what we do for any high deductible plan. We have them pay the expected patient portion on the way out. It helped tremendously.
                        However even though high deductible plans are becoming more common they are still the minority.

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                        • #13






                          That is what we do for any high deductible plan. We have them pay the expected patient portion on the way out. It helped tremendously.
                          However even though high deductible plans are becoming more common they are still the minority.
                          Click to expand...






                          some places charge and collect their negotiated fee up front; any refund due to having met a deductible will be provided later. It will turn some people off and maybe they’ll leave your practice or not come in the first place, which could be a good thing. most who intend to pay their bills should have an understanding of why it has to be that way.
                          Click to expand...


                          Is it legal to do this?  Will insurance contracts allow it?  I thought you couldn't collect until claim is processed.  I hope I am wrong because I always wanted to do the same but I was told I can't by my attorney.  Maybe he needs to look into it further.

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                          • #14
                            Honestly I don't know. I am thankful of my employed status when it comes to things like this.

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                            • #15









                              That is what we do for any high deductible plan. We have them pay the expected patient portion on the way out. It helped tremendously.
                              However even though high deductible plans are becoming more common they are still the minority.
                              Click to expand…


                               




                              some places charge and collect their negotiated fee up front; any refund due to having met a deductible will be provided later. It will turn some people off and maybe they’ll leave your practice or not come in the first place, which could be a good thing. most who intend to pay their bills should have an understanding of why it has to be that way.
                              Click to expand…


                              Is it legal to do this?  Will insurance contracts allow it?  I thought you couldn’t collect until claim is processed.  I hope I am wrong because I always wanted to do the same but I was told I can’t by my attorney.  Maybe he needs to look into it further.
                              Click to expand...


                              I don't think not being able to charge up front is accurate.  I know of several, well-respected, large groups in my field that do this.

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