Up Front Collections

LanaW

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This is the scenario:

Patient is scheduled for (let's say) a colposcopy-we contact the insurance carrier and get the eligibility/benefits - if pt has not met deductible and the procedure is scheduled in the very near future we ask for that payment up front. We are now being told by a patient that this is illegal to do and that we can not collect moneys until we get an EOB. She has been in practice management and seems to think she is correct..

Any ideas? Or any suggestions where I might get some info regarding this topic?

Thanks in advance!
 

mbort

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It is not illegal to collect up front....HOWEVER I would check your contract verbage for her insurance carrier. We have some carriers that have a clause in our contract that specifically states that we can not collect the deductable/coinsurance up front.

If you have no clause in your contract then I would call the patient and explain to her that there is nothing illegal about it and that it is your office policy to collect this money up front.

Hope this provides some insite :)
Mary
 

dmaec

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well, my line of thinking on this issue is - how do you know "exactly" what will or won't be covered? Problems may present at surgery which would open a whole different can of worms as far as what's covered and what's going to go towards your deductible - not to mention, perhaps they'll have a "few" more appointments with other providers for whatever reason, and those charges may be set against their deductible... too many ifs and buts in paying up front based upon the prior auth for it.
Personally, I don't pay any of my medical bills until I review my EOB for the charges. They only thing I ever pay up front is my office co-pay - that's it, nothing else. My parents are elderly, and I take care of their medical bills the same way, we go over the charges once the EOB's are available and pay accordingly. Sometimes we end up contacting the facility for them to do more research for better dx's, resubmit the claim, etc. I won't say it happens often, but there have been times when we've caught mistakes made by the facility billers or the insurance carrier.
{that's my opinion on the posted matter}
 

gjw4128

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I agree with Mary. The majority of your carrier contracts do stipulate that you do not collect up front but bill the insurance carrier first. Know what the contract states. The insurance carrier is going to tell your insured that it is a violation to collect up front. This is only for carriers that you actually have a signed contract.

Also there is the problem of offices basing their prepayment on the total cost of the procedure, not the allowable amount which results in significant overpayments.

Gayle, CPC
 

LanaW

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Thank you to all of you who responded

THANKS! I'll take a look at the contracts and we do base the prepayments on an estimate of what is normally done with a particular procedure understanding there might be more or less done - it is just an estimate. We do use our contracted fees to estimate this prepayment....

Thanks again to all!
 
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