Wiki Collecting Deductibles/Coinsurance - Help

[kfrycpc]

Hello,

Our ASC is soon going to implement the practice of collecting deductibles/coinsurance up front. We anticipate this being an issue due to the fact that some of the physicians are collecting these monies prior to the pt coming to our facility, as explained below:

The patient pays the deductible/coinsurance to the physician.

We normally always get our bills in first before the physician and when the patient receives OUR bill for the ded/coinsurance, they tell us they already paid the physician.

I have called the drs office and they explained that their policy is that once they receive payment/EOB for their charges, they cut a check to the patient for the difference between what is owed to them, and at that point, the patient can pay us.

The resulting problem is two-fold: The patient is not willing to pay us (obviously), when they receive their statement, and, it also has a negative impact on our A/R.

Has anyone encountered this and if so, what have you done to remedy it?

Thank you.

 

[JesseL]

You should check with the insurance if you're allowed to collect up front. Insurances like Fidelis or Blue Cross Blue Shield restricts you from doing so if you're in-network. I had a patient we collected the estimate deductible up front and then a week later came back angry and yelling at every one, accusing us of scamming him, because he went and call Fidelis and they told him we were not allowed to collect up front. The claim was already processed and it turned out to be like $10 less than what he paid and we were going to refund him the difference, but he demanded the full refund amount of what he paid in cash and to send him the bill, just to be a total ass about it. We can't argue with him because it was true we were not suppose to collect anything from him up front thanks to Fidelis's stupid policy.

Insurance like Aetna and Cigna and United Healthcare, that I know of, allows you to collect up front, since they have a "cost estimator" or a "fee schedule look-up" function on their web portals.

Really, I personally think insurances do this because when they sell the insurance to patients, they don't explain to them what a deductible is and the patients end up signing up thinking everything is covered, and then the sales rep can laugh and get his/her commission. And then when we collect money up front, they're going to of course call the insurance and complain. And then the insurance tells us we're not allowed to do this, and then we have to give the money back to the patient, just so we can bill him and hope he/she will pay for it. Really a pain that insurance don't care if we get paid for patient's deductibles. Nothing is enforced and they don't let us collect up front, most of our patients are "fresh off the boat" or probably get paid in cash and cheat the government one way or the other, so most of them don't care if their credit is ruined by collection agencies.

 

[chilipepper218@gmail.com]

I have definitely encountered this unfortunate situation and I would suggest that when you get the EOB from the insurance company showing that amounts were applied to the patient's deductible to call the patient before sending the bill and explaining that their insurance company processed your claim BEFORE the physician's claim and that their physician will almost certainly be refunding an amount to them because of it. That way, they will at least know what happened and that the deductible amount ended up being owed to your office instead. Most times patients just need a little information to help them feel more comfortable about insurance and how it works. We understand it because we deal with it every day, but it gets confusing to them sometimes

I hope this helps!