Poll

Is it illeagal in anyway to collect copays and deductibles upfront in a chiropract ic office. For example, if a chiropractor determines that a patient needs 10 visits for the year and then asks for payment of deductible and copay for all ten visits, is th

Is it illeagal
0 (0%)
Is it against provider contracts
0 (0%)

Total Members Voted: 0

Voting closed: April 22, 2009, 05:39:53 PM

Author Topic: Collecting copays and Deductibles up front  (Read 4302 times)

aftrdoc

  • Newbie
  • *
  • Posts: 1
Collecting copays and Deductibles up front
« on: March 23, 2009, 05:39:53 PM »
I would love to know the answer because i know many chiros that do this and there are at least 3 practice managment groups that say this is legal, I call many different places,i.e. insurance companies and state insurance commisiones and get differing views, can you please set me straight.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4705
    • Solutions Medical Billing
Re: Collecting copays and Deductibles up front
« Reply #1 on: March 23, 2009, 07:41:48 PM »
Laws vary from state to state, but it is definitely against provider contracts to charge the patient for copays for future visits.  Copays are to be paid at the time of service, not before not after.  Insurance companies are looking for those providers who engage in that practice. 

I got this info from a provider rep for a very large insurance carrier. 

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Pay_My_Claims

  • Guest
Re: Collecting copays and Deductibles up front
« Reply #2 on: March 24, 2009, 02:51:52 PM »
Laws vary from state to state, but it is definitely against provider contracts to charge the patient for copays for future visits.  Copays are to be paid at the time of service, not before not after.  Insurance companies are looking for those providers who engage in that practice. 

I got this info from a provider rep for a very large insurance carrier. 

Michele

Yes, its simple, you can not future charge a patient. What if that client should move, pass away, or decide they no longer want your services?? I have no idea why any provider would do this. As far as the poll goes, I really can't answer it. It doesn't have an option for me. I can't say that its ilegal or against provider contracts, because I have never seen one state you can't collect for future charges, but it seems too common sense to me that a provider shouldn't.

PMRNC

  • Hero Member
  • *****
  • Posts: 4217
    • One Stop Resources & Networking for Medical Billers
Re: Collecting copays and Deductibles up front
« Reply #3 on: March 25, 2009, 06:16:15 AM »
I agree with the others, it is illegal to charge the patient for services NOT rendered along with it being a violation of the plan.  A lot of providers don't even know it's technically wrong to collect the co-pay before the patient goes in for their visit, but many do that to avoid having to collect it AFTER they render services. A while back, I  took my daughter to a dermatologist. Our appt was set for 1:00, I picked her up from school at 12:15 and we were there by 12:40. I completed the paperwork and wrote them a check for our copay (which I felt un-easy doing and was the first time I did this)..
At 2:00 we were still in the waiting room.. at 2:30 I inquired as to the wait and was told the doctor was overbooked today, it would be just a little while longer. at 3:15 I was furious and told them we were leaving, asking for my check back, to which the office replied it was logged and recorded and that they couldn't do that but would apply it to our next visit! Well I was NOT going back to that doctor so I insisted and she told me the best she could do was send the check back. At that point I should have called my PPO, but I gave them the benefit of the doubt..3 days later, no check so I called them and they said they do their A/P monthly and I should expect my check back by end of the month. Now I was really livid at the whole situation. I contacted my PPO (at time it was BCBS)  The rep informed right then and there that what the office did was in violation of the plan policy because they had took money for services NOT yet rendered, in addition it could technically be fraud. I was a claims examiner so I knew this but I had just given the office the benefit of the doubt. Later on I had a client that wanted to begin doing that and I told him he couldn't.

Linda Walker
PMRNC
www.billerswebsite.com
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4705
    • Solutions Medical Billing
Re: Collecting copays and Deductibles up front
« Reply #4 on: March 25, 2009, 06:37:31 AM »
If the office collects the copay up front and the patient decides for whatever reason to not follow thru with the appointment they certainly should be more than willing to return the copay, but I'm not surprised by your experience. 

I'm actually not only amazed at the number of providers (commonly chiropractors) who do this 'up front' charging system.  There is actually a group that goes around the country doing seminars to 'teach' them how.  But what surprises me more are the number of patients (and I've known some) that agree to this and PAY! 

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

PMRNC

  • Hero Member
  • *****
  • Posts: 4217
    • One Stop Resources & Networking for Medical Billers
Re: Collecting copays and Deductibles up front
« Reply #5 on: March 25, 2009, 06:44:47 AM »
I think they are trying to have their cake and eat it too!! LOL
With Concierge medial services on the rise, doctors just see the dollar signs, not realizing this can be done (collecting ahead) but NOT with Insurance. I know in NJ there is a pilot program going on right now where they are actually seeing nice results. Patient's pay an ANNUAL fee and they don't have to have long waits to see the doctor and they can come in as often as they need. But that's a whole different ball game.
I'm consulting with a very large practice a couple hours away where we are on a 1 year plan to rid them of ALL insurance billing and they are going to be doing something similar.

Linda Walker
PMRNC
www.billerswebsite.com
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4705
    • Solutions Medical Billing
Re: Collecting copays and Deductibles up front
« Reply #6 on: March 25, 2009, 06:50:47 AM »
Sounds interesting.  If it works, many doctors will be interested.  If you ask a doctor what he hates most about this industry I bet 99% would say insurance!

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com