Payments > Patient Billing
Predetermination patient responsibility
PMRNC:
From doing some google searches I came across a software based overseas I believe does real-time eligibility and verification benefits www.intake.io it looks like a standalone and has place for patient to enter demographics from an Ipad.
NOW.. as far as collecting BEFORE the visit.. I have a problem with this and I believe you could easily make a case out of it. Most insurance polices have their cost provisions in their summary benefit plan book that will specifically say "at time of visit". Same with physician contracts with carriers and I'd be sure to bet taking copay before a visit would in fact violate some of those contracts. I personally would NEVER pay my copay until checkout. I took my daughter to a dermatologist (only one in a 100 mile radius) who wanted our copay and deductible up front. I had no choice, I paid it and then we sat in the office for 3 HOURS to see the doctor.. I went up to the desk and told them I wanted my check back or I'd walk out and go straight to the bank and stop payment. She handed me back the check and said she would have to re-schedule the visit. :o :o :o upon talking to other patients in the wait area, this doctor does that because he can because he's only dermatologist in a 100 mile radius.. well that's ok, not THIS patient. Ended up going to another state to see a doctor. From my point of view that doctor owed ME money for sitting there for 3 hours!
Cpatel:
--- Quote from: PMRNC on June 08, 2015, 11:51:11 AM ---From doing some google searches I came across a software based overseas I believe does real-time eligibility and verification benefits www.intake.io it looks like a standalone and has place for patient to enter demographics from an Ipad.
NOW.. as far as collecting BEFORE the visit.. I have a problem with this and I believe you could easily make a case out of it. Most insurance polices have their cost provisions in their summary benefit plan book that will specifically say "at time of visit". Same with physician contracts with carriers and I'd be sure to bet taking copay before a visit would in fact violate some of those contracts. I personally would NEVER pay my copay until checkout. I took my daughter to a dermatologist (only one in a 100 mile radius) who wanted our copay and deductible up front. I had no choice, I paid it and then we sat in the office for 3 HOURS to see the doctor.. I went up to the desk and told them I wanted my check back or I'd walk out and go straight to the bank and stop payment. She handed me back the check and said she would have to re-schedule the visit. :o :o :o upon talking to other patients in the wait area, this doctor does that because he can because he's only dermatologist in a 100 mile radius.. well that's ok, not THIS patient. Ended up going to another state to see a doctor. From my point of view that doctor owed ME money for sitting there for 3 hours!
--- End quote ---
Thanks Linda. I will do some research.
kristin:
--- Quote ---I was surprised and asked to frond desk rep that how did they figured out that what level of services will be billed to insurance without even seeing the doctor. She said based on the problems I told over the phone at time of appointment, Dr. has predetermined the level of services.
--- End quote ---
This is just wrong, wrong, wrong. I would never see a doctor who does this. If they are doing something like this, I wouldn't want to know what else they are doing that is wrong. I couldn't trust an office/doctor with that kind of policy in place.
As for what the insurance rep told you, do you think maybe they were confused by what was being collected before the services were rendered? A co-pay is one thing, but a level of service allowed amount is something else.
PMRNC:
--- Quote ---As for what the insurance rep told you, do you think maybe they were confused by what was being collected before the services were rendered? A co-pay is one thing, but a level of service allowed amount is something else.
--- End quote ---
There are managed care plans that have copay's based on level of services. For example a straightforward office visit might have copay of $10 where a blood draw or immunizations etc, might have no copay. (just an example). Before my own plan change in Jan I had a level of service copay where I only had a copay for the intial visit, none for subsequent, there was a copay for labs, none for surgical.. etc. Usually your big companies with various levels offer these plans and employee chooses.
I THINK that's what the original poster was talking about.
Cpatel:
--- Quote from: kristin on June 08, 2015, 10:16:29 PM ---
This is just wrong, wrong, wrong. I would never see a doctor who does this. If they are doing something like this, I wouldn't want to know what else they are doing that is wrong. I couldn't trust an office/doctor with that kind of policy in place.
As for what the insurance rep told you, do you think maybe they were confused by what was being collected before the services were rendered? A co-pay is one thing, but a level of service allowed amount is something else.
--- End quote ---
I agree with you. I have high deductible plan so doc's office rep said they are collecting deductible and I specifically asked that how can you determine the level of service without patient being seen by the doctor. Rep said that doc decide level of service based on the problems mentioned at time of appointment. We all know that doctor's do not have time to go over the scheduler and also no doc can predetermine the level of service without examine the patient. When I called insurance, they did not had the claim on file so rep just gave me generic information that providers are allowed to collect deductibles in front.
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