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01/31/2015    R. Alex Dellinger, DPM,

Handling Patients with High Deductibles Who Refuse to Pay (Elliot Udell, DPM)

There is no question this is a problem all across
the country. I will tell you that you absolutely
need to know what a patient's deductible is and
what they would owe BEFORE they get to your
office. We verify insurance on EVERY new patient,
or an established patient when their insurance
changes. It has to be communicated to the patient
that payment will be expected at the time of
service. And this needs to be communicated as
long in advance as possible.

Find out how they are going to pay when they
arrive to check in. If they can't /won't pay, you
don't see them. Period. Period. Period (there
are exceptions to every rule - we see them, say,
if they are diabetic and have pus dripping out of
their foot, etc. or if a family physician calls
and wants us to see a specific patient for them).

The problem with collection agencies is that - at
least mine - charges 36%. That's on what they
collect. And they typically don't recover 50% of
what is turned over to them. In other words, you
won't get a pittance of the original balance. If
you are worried your schedule will be "reduced"
because you aren't seeing them, please don't.
Others (who pay or have "good" insurance) will
fill those slots. And if they don't, you just
saved yourself the gauze, bandages, injectables,
staff time, etc. that you would have provided "for
free." I can assure you that since our office
has gotten more streamlined and up front about
collecting deductibles and co-pays, our cash flow
has dramatically improved.

R. Alex Dellinger, DPM, Little Rock, AR

Other messages in this thread:

02/03/2015    Michael M. Rosenblatt, DPM

Handling Patients with High Deductibles Who Refuse to Pay (Elliot Udell, DPM)

I am very concerned about a recent group of
discussions on PM News about patient co-insurances
and deductibles, and the difficulty in collecting
them. And it is getting much worse. As we know, it
is often AGAINST the law to forgive deductibles
and co-insurances, especially from

1. By "forgiving" a deductible and co-insurance,
or at least not making a stern attempt to collect
it, you are basically charging "less" for the
procedure/service then you are actually billing.
This could be considered fraudulent under certain

2. Insurers look to doctors who forgive portions
of their billings as audit targets. If you are one
such biller, you can expect a demand for the %
that you deducted and did not charge to be
reimbursed to the insurance company. And they WILL
go after you for that.

3. Insurers charge a hefty co-insurance precisely
BECAUSE they expect the patient to cover part of
the costs of their treatment. When you are forgive
co-insurance and deductibles, the insurers regard
you as not fulfilling the terms of your agreement
with their panel. Removing you from their panel is
the least egregious thing they can do to you.

When patients ask you "why they should pay their
expensive deductible and co-insurances" your staff
should simply tell them that waiving them might
well be considered illegal, and that you could be
prosecuted for healthcare fraud. When your patient
made an agreement with their insurer, they may
have purchased a less expensive plan that covers
much less. Your insurer does not want THEM to
think that they got more for their money than the
plan covers.

No patient in your practice is worth paying 25-
50,000 dollars legal defense costs, or going to
jail because they want a free ride. This is not
merely a matter of how you get paid. By not paying
your co-insurance and deductibles, in most cases
they are asking you to do something that is

When your patient says that "Dr. X" doesn't
charge, you should simply advise them to go to the
other doctor. You can consider yourself lucky to
lose that patient. They will be the very first to
testify against you in any action that the insurer
or Medicare takes against you. You both might be
reading about that other doctor in the newspaper:
"being charged with healthcare fraud." But at
least it won't be you.

Start seriously collecting those balances now, or
better yet, get them up front, as many doctors
here have written. It is time for doctors to stop
"apologizing" for some "insurance plan" that your
patient subscribed to. They must be made to bear
the burden of that decision. If you have less time
filled that day, study for your boards or read
some journals. Your time will be much better

Michael M. Rosenblatt, DPM (Retired), San Jose, CA
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