Wiki Collecting deductibles prior to surgery

[Prissyz1]

I work for an ocular plastic surgeon. In the past our provider was not a stickler on collecting the deductibles prior to surgery. What I have found is that our provider gets the claim to the insurance first, therefore our claim gets applied to the deductible. Then our office has to bill these patients their portion. A majority of them NEVER PAY! The facility where the surgery takes place, collects for the deductible up front. So, when these patients know they have overpaid from the surgery, they ask for a refund from the facility. Then they receive their refund check, and never pay our provider. This means a lot of these patients are getting very expensive surgeries for free. My question is this: I had a patient just state to me that her insurance stated we were "double dipping". I explained to the patient exactly the information above. I feel our provider is entitled to his share, just as the facility is. How would your office handle collecting deductibles prior to a surgery? Would you continue to keep collecting the dedcutible prior to surgery? TIA

 

[aciardelli]

I used to work for an office that did this. We just explained to the patients that this actually makes it easier on them, since it will be one last bill they have to worry about while they recover. We also had a form that the patient signed showing what the insurance company told us would be their portion and how everything would add up. I found it easier to collect from them once they had an understanding.

 

[ssharp]

deductibles

We did collect deductibles up front. But some home when we verified their insurance we were able to look at the deductible and we had a cheat sheet as we called it with the codes that the physician would be charging for their portion of the procedure and we would collect toward the Physician charges and we let them know this did not apply to any facility charges. They knew it was their providers portion only. If it was a very expensive procedure or if they were close to meeting their deductible there were times that we took a portion of the deductible up front. This really helped. Like I said when we collected we let them know it was the provider portion and we also collected it before we scheduled the procedure and left it posted in the system and then applied it to the charges once posted.

 

[avon4117]

ssharp...and we do it the same way. There are times when the facility claim would get to the insurance company before ours which may leave the patient a credit. However, I would rather refund a patient then to risk not getting paid at all.

 

[JesseL]

Some large payers like Empire BlueCross BlueShield does not allow you to collect deductibles or estimates up front. Some patients call their insurances to complain and then the insurance calls us and tells us we're not allowed to do it. Others like Cigna and Aetna allows you to collect up front since they have a cost estimator system on their websites. It's really a crappy system that the some insurances lets patients have a chance to run out on us (dine and dash basically) after services are rendered.. Most of the patients that call their insurance to complain dont even know what "deductibles" are.

 

[tmanfull3322@aol.com]

In the case of insurances who don't let you collect up front, you can report the patient who doesn't pay to the insurance company, stating that this is a violation of your contract with them. They are supposed to help by contacting the patient for you. I don't know how much pressure they would actually place on the patient, however.