July 22, 2014

Question:

Jennifer:

I work for a solo physician practice and it's always been an issue collecting deductibles / Co-pays / Co-insurance.  I don't see patients at the office, so I don't have the face to face interactions that could make this process more manageable.  All patients are seen as inpatients in the hospital.  I only get their face-sheet for billing purposes.
 
My policy is to send 3 statements, and on each statement I include a note asking if there's a secondary insurance, or if their insurance has changed, and that we are willing to work them to please contact our office. 
 
Nothing has worked.  Is there a law that requires patients to pay their out of pocket cost for services rendered.  I know we are required to bill the patient and it's illegal to bill only the insurance.
 
I appreciate your input in this matter.
 
Thanks,
B

Answer:

The responsibility of a patient to pay co-insurance (co-payment, deductible,etc.) is contractual, stemming from the patient's agreement with its insurer, with the patient accepting an amount of responsibility along with the benefit of his/her policy.  I was reluctant to respond to this question and send out today's email (hence its late delivery time) because of the rumors (yet, unconfirmed) that Obamacare plans are refusing to reimburse without proof of payment of co-payments and deductibles.  I am not aware of any federal or state laws applicable to such a denial, and would request any readers who have experienced such a denial to please provide me with documentation related to such a denial so I may review. 

I am aware of audits being conducted right now by carriers searching for confirmation that co-payments and deductibles are being collected - this has been going on for years and interesting because of the potential implications or potential end game for the carrier - by way of explanation - it is not clear through such a line of inquiry what the carrier aims to gain.  If the carrier is not determining its fees based on billed charges (usual and customary tabulation, as previously the case, not so much anymore), then what bearing does the collection have on amounts owed to the  provider?   Under such circumstances the result of such inquiry would likely be of more interest to the Attorney General or other state equivalent agency interested in enforcing insurance contracts and insurer rights (possibly the Department of Financial Services in NY). 

B, good question.