Payments > Patient Billing

High Deductible plan

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Kinlaw30:
Could provider bill patient upfront for payment if patient has high deductible plan? Could someone elaborate on this and give more information. Exactly how does this work? I know the NC hospital system charge the patient an estimate cost for the visit on that day due to high deductible... If patients pay upfront. Claim still has to be filed with insurance correct?

Thank you

Michele:
If a patient has a high deductible plan the provider can request payment up front, except with Medicare.  Medicare does not have a high deductible and you have to go by the Medicare allowed amount, so you can't really bill the patient up front.  And you don't know that another provider isn't going to get their claim in ahead of yours.  But with high deductible plans you can estimate what will be applied to deductible and charge patient.  But if patient pays more than what is allowed you have to credit them or refund them.

Yes claim still has to be filed to carrier.  Otherwise carrier won't have the charges to apply to the deductible.

Kinlaw30:
Thank you! 😊

PMRNC:
It's important that you establish one set of policies on deductibles and collecting up front. For example, I have clients who see a lot of patient's with high deductible plans so each client has a policy on how those are collected. We offer three payment plans for patients to choose from, they pick one and they sign a payment agreement. In the policy it also tells the patient that if for any reason their deductible is met prior to their payment made to us they should bring in their EOB and we will consider the deductible paid down. Having one policy helps the provider not have to go into financial details at the patient's visit and work with the billng staff instead. Also all patients are then treated equally. The front end staff also verified the benefits and deductible amounts paid to date with each visit because, of course, claims get processed at the carrier in the order they are received. If we have a patient scheduled for surgery who has not met their deductible we will request a 20% down payment. On morning of, or the day before benefits are checked again. For very large surgical claims we will usually hold the surgical claim for two weeks to allow the anesthesia bill and hospital bill to get processed.

Nancyo2:
The physicians in our office do not participate with any insurance plans so we often have patients with high deductibles. ($3000-20,000) In checking benefits we ask if there is a Health Savings Account (HSA) - if we understand this account correctly, its  used to pay doctors for co-pays, coinsurance and deductible amounts applied to claims.  We've had some success in using this account to collect some deductibles from the claims, however, some patients believe the money in this HSA is their money and it doesn't have anything to do with the insurance plan. Our office believes the insurance payment or HSA is basically the same. Either the insurance pays or HSA pays for deductible etc applied to claim.

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