Ethics

[ricktrudy]

I am new to this forum and have a question about deductible ethics.  Is it ethical for a provider to hold every claim in order for the deductible to be met, before they send the claim to the insurance company.  I have a provider that wants us to hold all claims that have a deductible until the deductible is met by another provider.  Sometimes we are holding claims for several months before they let us release them.  Any advice anyone can give me on this would greatly help. Thanks.

[DMK]

I don't think it's really a question of ethics, but it's poor business practice.  I understand not wanting to have to get the patient to pay and being the "bad guy" over money, but it is what it is.

1. If the patient has a deductible, they should know it and pay at time of service (so doctor gets his money, or a portion of it, right then, that's good).  With deductibles going up every day (mine just went from $3500 to $4100 and I had NO choice in the matter) the doctor is going to have to address his collection policy soon.

2. If he waits until their deductible is met elsewhere it may be a LONG time before he gets anything (unless he knows there's an MRI or surgery in the very near future that will eat up the deductible).  The doctor needs cash flow!  Why not collect as soon as possible?

3. and most important!  Insurance companies have a time limit to file claims, some are only 30 days!  The doctor could get shut out completely!  You do not get paid on untimely claims, and you usually can't collect it from the patient when it was your fault the claim wasn't filed timely.

Hope that helps!

[ricktrudy]

Thank you for the information.  I appreciate your response.

[PMRNC]

It is really NOT unheard of for some specialties to hold claims just a few weeks, for example chiropractors, mental health providers all see patients once or a few times a week so it's not really a big deal to hold for a bit.. long as you know the timely filing limit and also I would only do this for the high deductible plans, make a cut-off amount. Carriers do process the deductible in the order in which they are received, so there's no real harm in holding claims as long as your not going over the timely filing limit and you are still receiving a health cash flow.