Author Topic: How to charge a patient up front when they have a deductible they haven't met?  (Read 2091 times)


  • Newbie
  • *
  • Posts: 7
When a patient comes to your office for a visit and you charge them up front based on the insurance deductible they haven't met, is there a method to use to know exactly how much to charge the patient based on that deductible?

Like if the amount they haven't met is $5000, how much do you then charge them etc?


  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4945
    • Solutions Medical Billing
That is the problem.  The amount that the provider can charge them is the allowed amount for that service with that insurance carrier.  (Assuming the provider is in network)  So unless you know the exact allowed amount for the service for the patient's insurance plan you can't charge for the deductible until the claim is processed.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF


  • Hero Member
  • *****
  • Posts: 521
To add to Michele's response, which I totally agree with:

1. You can obtain fee schedules for various insurance companies either on their websites, or by requesting them directly from the insurance company. Some insurances also have a cost estimator on their websites. This will allow you to know exactly how much to charge the patient when they are in the office.

2. Make sure the doctor's contract with the insurance companies in question allows them to collect anything other than a copay upfront. Some do not.

3. If you are going to collect deductible money upfront, you had better make sure the claim is being submitted on the same day, or you will run into problems. My office does not collect deductibles upfront, and we submit our claims each day. More than once, we have met a deductible for a patient who already paid the deductible at another office, and that office didn't submit the claim until days, weeks, or even a month later. Thus causing the patient to be very irate with US when we sent them a bill for their deductible, even though they should be irate with the other office.


  • Hero Member
  • *****
  • Posts: 4356
    • One Stop Resources & Networking for Medical Billers
I do ped's and mental health, my clients at checkout can easily determine pretty accurately what the patient should pay at time of visit. For our patients that have higher out of pocket deductibles we have payment plans setup so they can pay down their deductible. Patients are also asked to bring in proof of their deductible being satisfied if what they say doesn't match what we have on file from verifying benefits. We anticipated a lot of problems with grace periods and deductibles a few years back and were able to re-do our financial policies to accomodate the high deductibles.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers