Payments > Patient Billing

Insurance vs. Patient Pay

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DMK:
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:
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.

DMK:
Thanks Linda!  I always like to back up what I "think" I know!

mforgione:
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:
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.   :-[

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