11/01/2018    Joseph Borreggine, DPM

Collecting Fees Upfront

This is a worsening quandary day by day in my
office: collecting fees upfront from the patient
when services are rendered. The old adage says, “
It is easier to collect money from the front door
than it is from the back door”. But, with ever
increasing deductibles in to the $5-10K range
many of the medical services and minor surgical
in-office services are not usually covered by an
insurance carrier until the deductible is met.

In this day and age, you would think the patient
would be more educated about their benefits, but
alas, they are not. They are ignorant in thinking
that the “copay” is their only responsibility and
the rest will be covered by insurance. That is no
longer true since the changes in healthcare due
to the Affordable Care Act (ACA).

Patients believe or opine deep down that
healthcare should be free and the doctor should
be the last one to be paid. Even with the changes
that have occurred with more of the financial
responsibility being put on the patient or
guarantor, the fact remains that doctors
continued to be thought of as “rich” and “cost
too much” so they can wait on their money. This
is sad, but true.

How we resolve this in our office is that we
check the patient’s benefits before they arrive
in the office. This is the case for patients who
are new and have not been in the office in
sometime. We then provide a courtesy letter
regarding their benefits with the explanation
that they will be responsible at the time
services are rendered for all fees up to the
amount of their deductible. When they arrive, and
when the patient is brought back to the treatment
room the office assistant reviews the benefits
letter with patient again. Before I see the
patient, the office assistant verifies with me
that they reviewed the information in the
benefits letter with the patient and that they
understand their financial responsibility.

When I see the patient and get their complaint
history and formulate a diagnosis, I then provide
the patient with a treatment plan including an
estimate of fees involved for the initial visit
and potential follow-up care. Most agree with
what is presented and are will to pay, but some
are not and will only be charged for an office
call. However, some are either ignorant of what
was presented to them or are just adamant about
not paying anything, but their copay because
that’s what they do at ever other doctor office
they visit.

This payment policy process does not include any
Medicare patients. Some insurance contracts limit
the ability to collect on any but the copay. So,
with that said, how are other independent
podiatrist handling this situation with their
respective patient population? Is there anything
inappropriate that I am doing in informing
patients of their financial responsibility and
collecting any monies due the day services are
rendered? Some may opine that having this policy
creates the atmosphere in the practice exudes
greed over treatment.

If anyone has any suggestions in improving or
refining this payment, then it would appreciated.
Also, if there is an illegality in this type of
office payment policy of collection please let us
know your thoughts

Joseph Borreggine, DPM, Charleston, IL

Other messages in this thread:

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11/02/2018    Charles Morelli DPM

Collecting Fees Upfront (Joseph Borreggine, DPM)

With total respect for Dr. Borreggine, I am
surprised that is question is still being
debated. With the exception of those who only
take cash and do not contract with any insurers,
whether you like it or not, we are in the
business of medicine and times have certainly
changed from what we all were accustomed to. They
changed years ago

Many will give examples of going to the store and
asking to only pay 80% for their groceries, while
others will comment on shopping at the mall and
asking the lady (sorry "person") at checkout if
they can pay when they come back to shop again in
2-3 months or they will suggest mailing a check.
Good luck with that. There is no other profession
where this is an issue. When my furnace blew, do
you think the plumber was going to let me just
pay for part of the service? These example can go
on infinitum so I will stop here.

Our policies are this. With our EMR we are able
to check the status of everyone's insurance
benefits. Everyone pays their copay and their
deductible BEFORE they are seen as a patient.
Period. If an appointment is made for an existing
patient for the new year, and we know that they
are going to have a deductible, they are told
this and they are also reminded prior to their
appointment. During the visit, if additional
treatment is going to be suggested or rendered,
it is discussed and the patient will either agree
or refuse the additional treatment (x-rays,
injection, etc.).

It’s very simple really. Get paid before you
provide your service by confirming and knowing
what their responsibility is, and never be shy
when discussing fees.

Charles Morelli, DPM, Mamaroneck, NY