Author Topic: discounts for hardship patients  (Read 4694 times)

Sophrosyne

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discounts for hardship patients
« on: October 13, 2011, 01:49:08 PM »
So from what I've read in various responses on this site, if you offer a patient a discount, the insurance company must be offered the discount as well. Is this true in hardship cases?
If we can offer a discount to the patient in a case of hardship, what kind of documentation do we need? Is the patient's word enough or do we need to ask for any kind of financial documents?
Thanks!

NuBiker

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Re: discounts for hardship patients
« Reply #1 on: October 13, 2011, 07:59:50 PM »
What we do is let them run up their bill. And we tell them when they receive the statement in the mail from us, ignore it. It does not happen often, but I do not see any way around it - we have to treat all patients equally (on paper).

DMK

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Re: discounts for hardship patients
« Reply #2 on: October 14, 2011, 11:23:44 AM »
Your provider's policies and procedures should already be established on this matter.  It is completely legal to set up financial hardship cases, but it needs to be set up from the initial visit.

Be really careful when they are an insurance patient.  There are more rules to these cases, since they have a contract with you and the patient.  They agreed to pay and you agreed to collect deductibles and copays, hardship or not, so document well!

Michele

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Re: discounts for hardship patients
« Reply #3 on: October 14, 2011, 12:35:57 PM »
It is up to the provider if he/she wants financial documents as proof.  The big thing is to document.  If the patient is lying, the provider can't help it.  As long as they've documented what the patient has told them and they believe it to be the truth, they are covered.  If the patient is lying, it's on them.
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Sophrosyne

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Re: discounts for hardship patients
« Reply #4 on: October 18, 2011, 09:44:00 AM »
Ok, so let's say we have the patient documented as a hardship case and we bill her insurance. Since it is hardship, are we allowed to discount what her insurance EOB lists as patient responsibilty?

Sophrosyne

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Re: discounts for hardship patients
« Reply #5 on: October 19, 2011, 10:55:47 AM »
Answered my own question with this helpful article! ;D
http://oig.hhs.gov/testimony/docs/2004/40624oig.pdf
So it looks like it's ok to discount or waive cost-sharing amounts on a case-by-case basis in order to help someone who is genuinely financially needy.

Michele

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Re: discounts for hardship patients
« Reply #6 on: October 21, 2011, 07:07:50 AM »
Yes you are correct.  Sorry for the delay - we had a terrible virus this week that knocked us out for 2 1/2 days!   >:(
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PMRNC

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Re: discounts for hardship patients
« Reply #7 on: October 25, 2011, 07:37:08 AM »
DMK said it the best. MAKE SURE IT IS IN YOUR PROVIDER'S P&P that should always be first place you go to for your answer on how to handle a procedure such as this and if it's not in there, get clarification and then make sure it makes it into your client's P&P!!   My clients have their hardship agreements on file along with a patient signature. What constitutes a hardship really NEEDS to be clarified on EACH provider's P&P and adhered to explicitly. for example, one of my client's financial hardship form is 2 pages long, he actually asks such questions as "Do you have Cable, please provide your cable companies name and monthly payment" reason being is that he feels if they can afford full cable with all the channels they can afford their $10 or $20 copayment. He's very fair but he's not an overly generous soul ..you would be surprised at some of the financial agreements don't even go into the clarification of what that provider constitutes a financial hardship when that really is important or you will have every patient claiming a hardship. Have the office come up with guidelines and adhere to them for every patient across the board with no special provisions, the terms should NEVER be on a patient-by-patient basis, but rather across the board with the patient's signature attached.  Good example, one of my providers had a patient for a couple of years with an arrangement on a one page hardship agreement (no terms) that they would not have to pay their copayment.. all was fine and dandy and then patient sued another provider for something and won a settlement enough to pay 20 doctors.. He never got a cent. I have another provider that covers that issue with an ROR (right of recovery) because he's also a lawyer as well as a family physician.  So you see these financial hardship agreements are NOT black/white..
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DMK

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Re: discounts for hardship patients
« Reply #8 on: October 25, 2011, 10:45:39 AM »
I know I will come across as harsh or cruel, and I don't mean to be that way at all, BUT..... I'm fed up to my eyeballs with people assuming that doctors all make a fortune and that they should all treat people for free.  They are a business providing a service, not a charity.  When a doctor or facility is willing to make special arrangements for you be grateful, because they don't have to! 

I always try to turn the tables.  You go to work and you expect to get paid for your work. Why should they be any different?

The extra twist is that the doctor or facility can get into serious trouble by making special arrangements, if they don't do it right! 

What the general public doesn't realize is that ALL doctors and facilities are constantly under the magnifying glass by the insurance companies, especially Medicare.  One infraction can open all their cases up to scrutiny, they get fined, and sometimes fined right out of business.  It's something a provider worries about constantly.  It doesn't matter how kind or generous they are, how a gifted a physician they are, there are paperwork technicalities and financial technicalities that can ruin them!

So be a little extra diligent for your clients and take their side a little more when they want to "waive" the co-pay, or the patients cry "financial hardship".  (That cable bill story is FABULOUS BTW, and very much to the point.)  Kindness can get the providers in a lot of trouble if they don't do it right.

PMRNC

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Re: discounts for hardship patients
« Reply #9 on: October 25, 2011, 11:01:53 AM »
Quote
I know I will come across as harsh or cruel, and I don't mean to be that way at all, BUT..... I'm fed up to my eyeballs with people assuming that doctors all make a fortune and that they should all treat people for free.  They are a business providing a service, not a charity.  When a doctor or facility is willing to make special arrangements for you be grateful, because they don't have to! 

I COULD NOT AGREE MORE!!  And let's not forget doctors are the most heavily govt regulated professionals in the country!! They are watched while even picking their nose! One of the first things I do when I take over a practice's billing is I go through ALL of their forms and their P&P, and compliance manual. I make sure they are consistent. There should be NO favorite patient's. A financial hardship practice should be in place from day one and adhered to to avoid special treatment. You don't know how many times I've gone into an office and asked for these and they don't have them.. that's completely unacceptable, I wouldn't expect a client to hire me without having a P&P or compliance plan! Normally this is how I will make some consulting cash too by offering to develop them. :)
Linda Walker
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Mazie

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Re: discounts for hardship patients
« Reply #10 on: August 13, 2015, 12:47:21 PM »
Quote
I know I will come across as harsh or cruel, and I don't mean to be that way at all, BUT..... I'm fed up to my eyeballs with people assuming that doctors all make a fortune and that they should all treat people for free.  They are a business providing a service, not a charity.  When a doctor or facility is willing to make special arrangements for you be grateful, because they don't have to! 

I COULD NOT AGREE MORE!!  And let's not forget doctors are the most heavily govt regulated professionals in the country!! They are watched while even picking their nose!

My sympathy for physicians is more limited because in the 1990s, physicians in this country danced with the devil by colluding with the insurance industry to torpedo healthcare reform. After that, not a single politician in this country dared utter the words "healthcare reform" for another 15 years and we ended up with this mess.

Once the goal of ending efforts at healthcare reform was accomplished, healthcare professionals passively allowed the insurance industry to completely take over the healthcare system in the United States. Now even people with insurance are being bankrupted or choosing to die rather than bankrupt their families. No other modern nation in the world is in this situation.

Physicians are now buried by insurance companies, but they brought it on themselves and instead of organizing and taking control over healthcare back, they dump the responsibility onto their patients. Physicians and billing professionals actually expect patients to ferry this convoluted system as if they are on the payroll as billing specialists! How is that reasonable or realistic? How can patients know all the intricacies of billing/coding when even billing specialists have trouble with it? And if they can't, how is it ethical to then stick them with huge debts and "go after them" for it?

The amount of stress and financial devastation caused to American families is staggering. When physicians are contributing to those high levels of stress, which in turn ravage families since money problems is the foremost issue that breaks up families, which in turn takes a toll on the entire nation on multiple levels, they are delivering bad healthcare.

The bottom line is, physicians have it tough but patients did not create this system. Insurance companies and healthcare professionals did. Physicians aren't going bankrupt. Their patients are.