Author Topic: Deductibles  (Read 1895 times)

datwood

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Deductibles
« on: September 19, 2013, 04:02:13 PM »
Hi! If a patient sees a specialist (endo) and their office verifies elig and but unable to check if ded has been met or not.  Can they request the allowable upfront from the patient (the dr is contracted with PPO plans) or the 80%?  I know that it is very time consuming to call to call the ins companies to verify if ded has been met. 

Can they resched or refuse the patient if the patient does not pay upfront?  They advise patients that all ded copays and bal are due at TOS.  If someone please help me please.

Thank you!
D

Sriram_Sub

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Re: Deductibles
« Reply #1 on: September 20, 2013, 03:26:48 AM »
Even if it is a Copay that patients have to pay upfront, no doctor tends to reschedule the appointment. Instead they will send the bill to the patient after the claim has been paid by the carrier(s). To my Knowledge, the physician can very well decide to reschedule or deny treating a patient if the patient already has a balance due and has never responded to any of our statements. In this case, the provider may try to get the balance settled at the TOS. But, this approach will not suit when the treatment is yet to be performed and a claim is yet to be submitted for the carrier to process (apply to deductible). It has to go through the proper processing.

Bottom line, expecting patients to pay a deductible amount upfront without submitting the claim to the carrier is as unfair as not using an Insurance coverage when you have one.
Sriram

DMK

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Re: Deductibles
« Reply #2 on: September 20, 2013, 10:40:40 AM »
This is really an office policy/procedure question that needs to be sorted out asap!

The office needs to find an efficient way to verify benefits and if the deductible has been met.  Most carriers have websites that are easy to check. That way the patient has no surprises when they show up for their appointment.

If you can't verify if the deductible has been met, you should at LEAST collect the co-pay.  That will be the minimum the patient will have to pay.  The office should also have a policy in place regarding payment of accounts so that can be gone over when the patient comes in, again, no surprises if they know what's required of them up front.

If the office takes several insurances, often, when the eob's come in, jot down the allowed amount as a sort of fee schedule.  Then when the patient asks "how much is this going to cost?" you will be able to tell them "your insurance allows $xxx.xx for this procedure, you have a $xx.xx deductible, and if the deductible has been met you have a $xx.xx co-pay".

It's smart to at least collect something at the time of service, if something will be owing.  "Endo" is not a specialty that people like going for, so they may really be unhappy with the cost of having something unpleasant done and may not want to pay the bill.  So, again, POLICY and PROCEDURE are vital for the doctor and staff to have down!  That way, no surprises and no offense taken when the bill comes!


datwood

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Re: Deductibles
« Reply #3 on: September 20, 2013, 11:09:27 AM »
I truly can't thank you enough for your responses! Thank you thank you!

PMRNC

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Re: Deductibles
« Reply #4 on: September 23, 2013, 04:18:45 PM »
Quote
To my Knowledge, the physician can very well decide to reschedule or deny treating a patient if the patient already has a balance due and has never responded to any of our statements.

Just to clarify, this is not simply the case. A physician has to follow certain procedures regardless of a balance or not in dismissing a patient from the practice.

DMK said it best.. get an office policy, stick to it and you won't have a problem. Yes verifying benefits can be a pain and a very daunting task, but it's ESSENTIAL to good practice management as it plays the most important role in overall reimbursement.  MAKE the time or hire someone else.
Linda Walker
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