When a patient comes to your office for service and is fortunate enough to have insurance, there usually is a deductible that must be met before the insurance company starts paying for submitted claims.

 

The patient is responsible for this deductible. This amount is extremely high in some cases.

 

Therefore, some patients are going to do what they can to get around paying their deductible while seeking medical care.

 

Asking the right questions when calling to verify patient insurance is vital. Within your insurance verification form, there should be space for information regarding patient deductibles. Your staff should know the patient deductible and how much of the amount has been met, if any, before the patient even walks into your practice.

 

When that patient arrives for their appointment, insurance information including the deductible should be front and center in their chart. This way, no matter which staff members welcome the patient, the information is visible, making them well aware of a deductible and the patient's financial responsibility to your facility before being seen by the physician. This financial obligation is required before their insurance will provide coverage for their medical care. 

 

If this slips through the cracks, you run the risk of that patient's deductible directly affecting your bottom line. For example, Jane Doe has chosen Beech Street Insurance to cover her medical care. Her monthly payment is low, but her deductible is $3,500. That means she must pay $3,500 before Beech Street will begin covering her medical care. That $3,500 will include anything regarding medical care, such as office visits, diagnostic exams, and in- or out-of-office procedures. If your practice charges $250 for an exam and the medical biller submits a billing claim to Beech Street before Doe has met her deductible, your billing claim will be denied. You cannot appeal this denial because the insurance company is not responsible for this charge. If your staff overlooked the deductible and did not collect it upfront, you are out of luck. The insurance company is not responsible for your mistake.

 

Now you have to send Doe a statement in the mail, billing her for an exam you performed that her insurance company is not required to cover. If Doe is the special kind of person that keeps bill collectors in business, you probably will not see that money. You can get a collection agency to help you, but that will cost you, which also affects your bottom line. There is not much you can do if Doe does not care about her credit score and is a professional at dodging financial responsibility.

 

A collection agency will charge you a percentage for their efforts, decreasing the amount given to you—if you get anything from the patient for services provided. That might not be your best option, especially if the dollar amount is low. Another option is collecting the debt via an attorney, but that practice can be extremely expensive, resulting in a financial loss because it is costing you more money to get some money. Ultimately, you are writing the amount off because it cost too much to actually retrieve it from a patient that knows how to work the system to their advantage.

 

Your best bet—and only option—is to make sure you know the amount of a patient's deductible before he/she enters your facility, and collecting the correct amount before the physician even touches the chart. Any written-off amount added several times over throughout the year will affect your bottom line. Be aware and current on the status of every patient seeking medical care at your practice to prevent patients from taking advantage of you and what you provide our community.