Author Topic: Co pay  (Read 1339 times)

gderilus

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Co pay
« on: July 06, 2010, 08:58:38 PM »
I have a couple of questions... A client called and was scheduled an appointment. They have a deductible for $3000, but they said that their work pays the first half. How do I go about collecting co-pays, if any? Should I just bill and if it's not covered, then we start billing the Client instead of the insurance company?

PMRNC

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Re: Co pay
« Reply #1 on: July 06, 2010, 09:50:44 PM »
They probably have either a flex account or an HSA, you collect the copay the insurance company tells you to collect and then bill the patient the balance if any and they can seek the additional reimbursement. Just make sure after you post the insurance payment you give he patient an itemized bill they can submit to their employer/HSA
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DMK

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Re: Co pay
« Reply #2 on: July 07, 2010, 10:48:18 AM »
I thought that if the patient has a deductible that hasn't been met, you were to collect the amount due (never mind the co-pay since that won't apply until the deductible has been met, unless the procedure had the deductible waived).  Then you give the patient a receipt so their cafeteria plan reimburses them.  If you wait until the insurance responds, bill the patient and then they have to get the money from their employer, it could take a LONNNNNG time.  If you get it at all.

Isn't their contract with their insurance company and ultimately what the patient owes, they owe, not their employer?

PMRNC

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Re: Co pay
« Reply #3 on: July 07, 2010, 02:33:39 PM »
That's what I basically said, patient is responsible for all out of pocket expenses, they can seek the reimbursement from their employer based plan, but they are ultimately responsible.
Linda Walker
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Michele

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Re: Co pay
« Reply #4 on: July 07, 2010, 09:56:51 PM »
I would ask the patient to clarify the type of account.
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PMRNC

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Re: Co pay
« Reply #5 on: July 08, 2010, 03:54:31 PM »
Quote
I would ask the patient to clarify the type of account.

It really doesn't matter, flex plan, HSA, cafeteria, etc.. those are private accounts with funds from the employee/company that can be used for out of pocket expenses, they are not maintained by an insurance company, they are private employer sponsored funds and it is the patient's responsibility to seek those funds on their own. They are still responsible for payment of out of pocket and cost sharing expenses of their insurance company and THEN seek reimbursement collection from those private funds. SOME HSA's will do an assignment of benefits but it's up to the patient to file the claim and assign the benefits. If you wait on an HSA or any other such plan, 9 out of 10 times you won't get paid, many times the patient will get the money and your out. Best to stay OUT of those situations by making it clear to the patient what they are responsible for.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com