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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
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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 Medicare/Medicaid.
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 circumstances.
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 illegal.
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 spent.
Michael M. Rosenblatt, DPM (Retired), San Jose, CA
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