Wiki Collecting deductibles at time of service

[csantiago]

Copays are due at the time of service, but what about deductibles? Can deductibles be collected up front? I spoke with an insurance company today and the rep stated that we were not to collect a patient's deductible upfront. Is this true in every situation?

 

[salberts]

Our surgical center has collected deductibles for years. None of our insurance contracts say that we cannot pre-collect on deductibles, coinsurance and copays. Insurance companies usually say you can't because they don't realize that it is possible for you to know the contract reimbursement for specific codes. You must be very careful in your out of pocket assessment. If you over collect, you must refund immediately or you may lose business. We have a person dedicated to verifying eligibility and deductible/out of pocket status. We then calculate the patient's out of pocket expense to the penny by pre-coding the service with known information and applying the contract rates. It has been very successful for us.

 

[MarcusM]

Deductibles

You CAN collect the deductible...the catch is how much of the charge being billed will go to the contractual allowable. Example: Patient has $1000 deductible, total charge you send to insurance is $1500.00, but the allowable is only $495.00. You should only collect the $495.00, and as mentioned in early post, be prepared to refund any credits within the deadlines. If the patient is going to multiple providers in a short time frame, your claim may hit later than others, and the deductible could already be met and the insurance pays you for your claim rather than applying to deductible...you would then need to refund the patient.