Author Topic: Insurance vs. Patient Pay  (Read 5538 times)

DMK

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Insurance vs. Patient Pay
« on: July 20, 2012, 01:42:57 PM »
I had a situation come up today and I want to make sure that I gave the correct information.

A patient has Insurance, we are in-network.  He has a high deductible, and an HSA account.  His last doctor told him it would save him money if he just paid the cash rate with his HSA and NOT bill the insurance. 

If we are in network, and he presents his insurance card, we have to bill the insurance card and charge the patient the insurance allowed amount right?  We can't just arbitrarily give him the cash rate and disregard the insurance.  I can see if they never mention the insurance, then it's self procured care, but if I have the insurance information don't I HAVE to bill the insurance? Particularly since we're in network (and preferred).


PMRNC

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Re: Insurance vs. Patient Pay
« Reply #1 on: July 20, 2012, 01:56:05 PM »
His last doctor got over on him  :o

HSA's shouldn't be factored into your fee schedules at all. The HSA is a Health Savings Acct between the employer and the insured.. What the insured does with the bill AFTER insurance has paid is up to them.

You are correct that the bill must be filed to the in network carrier and then he can submit the EOB to his HSA for any out of pocket. If a bill is submitted just make sure that the bill you provide him shows full charge, insurance payments and insurance adjustments. His HSA is only going to pick up out of pocket.

We are going to see a lot of HSA's pop up in next year or two because the ACA puts HSA's in great danger, so employee's are going to be trying to use up their monies now.
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

DMK

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Re: Insurance vs. Patient Pay
« Reply #2 on: July 20, 2012, 04:02:18 PM »
Thanks Linda!  I always like to back up what I "think" I know!




mforgione

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Re: Insurance vs. Patient Pay
« Reply #3 on: August 01, 2012, 09:30:50 PM »
Not to ask a stupid question....I posted something similar before, but is it legal to have a patient pay (patient who has no insurance or an insurance the provider does not par with) pricing schedule?

DMK

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Re: Insurance vs. Patient Pay
« Reply #4 on: August 02, 2012, 11:24:39 AM »
You can have a cash price for patient's with no insurance.  It should be fair though. Our cash price is based on the average "allowed" amount of the insurances we contract with.  If we can take the cut from the insurance company, we should take it from the patients who don't have insurance.  We don't want our care to be out of reach, financially, for our patients. 

Just a side note, I will say that the patient's who have to pay out of their own pocket appreciate the doctor SO much more than people who never get a bill. Worker's Comp patients have a tendency to be the most abusive of care since their job "owes it to them".  They flake on appointments and we can't charge for the missed appointment.  Just a pet peeve of mine.   :-[

gurumedbill

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Re: Insurance vs. Patient Pay
« Reply #5 on: March 22, 2013, 10:07:09 AM »
I just want to throw my two cents in on this topic...
What the office charges a patient is completely up to them.  They can essentially charge anything they want.  With that said I believe they should get the best price out there.  If you ask any doctor they will say they have all wish they were a cash only practice (and by cash I just mean no insurance).  I do bill for one office like that and as you can imagine it is a breeze.  Sure the more offices that don't deal with insurances means it is less likely they will need our services but that doesn't change the fact that cash patients are the easiest to bill for. 
In a nutshell...they can charge whatever they want...but in my opinion they should pay less than any insurance out there because of they cost the least to bill.
Of course there are those that are deadbeats but that is for another thread all together.

PMRNC

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Re: Insurance vs. Patient Pay
« Reply #6 on: March 22, 2013, 10:18:57 AM »
Quote
What the office charges a patient is completely up to them.  They can essentially charge anything they want.  With that said I believe they should get the best price out there.  If you ask any doctor they will say they have all wish they were a cash only practice (and by cash I just mean no insurance).  I do bill for one office like that and as you can imagine it is a breeze.  Sure the more offices that don't deal with insurances means it is less likely they will need our services but that doesn't change the fact that cash patients are the easiest to bill for.
In a nutshell...they can charge whatever they want...but in my opinion they should pay less than any insurance out there because of they cost the least to bill.
Of course there are those that are deadbeats but that is for another thread all together.

I agree, however if you have an all "cash" practice, what you charge won't mean squat if your not collecting 100% up front. I converted a practice to all cash last year and it was NOT a breeze. One of the things we made sure we did was post notices, mail every patient a notice (MORE THAN ONCE). 6 months in advance (for BCBS Contracts it was longer). When the "magic" day came their staff confirmed appts the day before and each patient was told what they were to pay in advance. Payments were collected prior to entering the exam rooms. This was NOT easy and the office staff did have a few bleeding heart moments but after about 3 months they had a 97% cash collection rate.. still working on the other 3 %.  There are patients that will still have hardship cases and we have the staff go the "route" with hardship agreements including a complete breakdown of all their income/bills to be fair to all patients. We have someone on staff who reviews these to be sure a hardship case is justified.  It takes a LOT Of dedication to run a cash practice, I think it's actually more disciplined on the staff/doctor than billing insurance where you have some lead-way with patients and balance.  One of the hardest things to do was to keep the doctor OUT of any payment talk aside from discussing care/future care, he let the office staff have full lead on the money issues so that he would NOT be tempted.   Also cash practices rely 80% of the area in which they are located too.   I'm pretty proud of this conversion, I am on a consultants salary only now as I only do follow up on the ones with payment plans, and any other compliance/policy issues the practice has.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Buglet10

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Re: Insurance vs. Patient Pay
« Reply #7 on: April 10, 2013, 08:58:41 PM »
You can have a cash price for patient's with no insurance.  It should be fair though. Our cash price is based on the average "allowed" amount of the insurances we contract with.  If we can take the cut from the insurance company, we should take it from the patients who don't have insurance.  We don't want our care to be out of reach, financially, for our patients. 

Just a side note, I will say that the patient's who have to pay out of their own pocket appreciate the doctor SO much more than people who never get a bill. Worker's Comp patients have a tendency to be the most abusive of care since their job "owes it to them".  They flake on appointments and we can't charge for the missed appointment.  Just a pet peeve of mine.   :-[