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Oceabrz
January 7, 2009 @ 7:07 AM Reply  |  Email Friend   |  |Print  |  Top

I work for orthopedic surgeons (South Florida) who have just recently started asking our patients to pay their unpaid deductible upfront before they can have their surgery.  In the end, we end up refunding a lot of money to these patients.  Is this reasonable? Legal?

steve verno
January 7, 2009 @ 7:38 AM Reply  |  Email Friend   |  |Print  |  Top

As a layperson, Ive seen nothng in FS 627.6131, 641.3154.641.3155 that prohibits collecting amounts patients owe such as deductibles at the time of service.

Some doctors hate making refunds. But I tell those doctors it costs 42 cents to refund than the $10he spends for every statement trying to collect the deductible later.

Oceabrz
January 7, 2009 @ 7:55 AM Reply  |  Email Friend   |  |Print  |  Top

Thanks  Steve, I wasn't sure.  One of our patients said their insurance company told her what we were doing was illegal, and I couldn't find any literature stating it was, so I turned to the one person I know that can answer just about anything....YOU!  :-)

I see you are a Ghost Hunter fan..........me too!

Charlene
January 30, 2009 @ 10:33 PM Reply  |  Email Friend   |  |Print  |  Top

There are some plans like Cigna (contracted providers) who can't collect ded/coinsurances up front. Make sure you are looking closely at the plan descriptions. For phy's who are collecting (good for them) it does save on the back end for collections. I suggest however to verify with the claims /benefits department to see how much has been met. Don't just look at the card. I know that if a MD tried to collect my 250 ded, and I know I just had an MRI....I would let him know that a claim has been processed and to call to check on my applied deductible.

steve verno
January 31, 2009 @ 2:31 PM Reply  |  Email Friend   |  |Print  |  Top

of course insurance companies ar going tosay what we do is illegal.  Bottom line is if a patient has a deductible, the are responsible for paying it.  Even a par provider is required to collect it, but with all of the contracts I have negotiated, none have language that prohibits collecting it at the time of service.  I can say that the insurance company will deduct the deductible from the contracted payment.  As a patient, I have paid mine when asked to pay it.  As a non-par provider, none of the insurance company's internal policies have any jurisdiction over my non-par providers.  

Ive had insurance companies call me with the patient on the phone when biloling their member.  The rude and obnoxious customer service rep chastizes me for billing their member.  When I mention I plan to bring this to the OIGs attention, they back down and suddenly, they tell the member that they applied the claim to their deductible and need to pay it.  ive had the insurance company tel me they will turn our billing their membe over to their fraus division.  I say I await their findings.  I usualy never hear back anything.  This is a veiled threat on their part to get me to back down. When we are in the right, we dont.  If I know this is an ERISA issue and I mention this and the fact I will report this to the Department of Labor, they also back down.  

Bottom line, a deductible is a patient contracted requirement for the patient to pay.  Ive seen no State or Federal laws prohibiting the collection of a deductible at the time of service.  This includes Florida's insurance laws:  FS 627.6131 and 642.3154 or 641.3155.

Oceabrz
January 31, 2009 @ 5:01 PM Reply  |  Email Friend   |  |Print  |  Top

Charlene and Steve, thank you!

Michelle Rimmer
January 31, 2009 @ 9:06 PM Reply  |  Email Friend   |  |Print  |  Top

Steve,

Does this apply to Medicare as well?  I had a client who collected the part B deductible up front in January when the pt's had no Medigap plan.........she was their PCP and they had seen no other providers before her so far.

Charlene
February 1, 2009 @ 10:03 AM Reply  |  Email Friend   |  |Print  |  Top

It has nothing to do with a state law. it was the contract provision Cigna incorporated. As stated if you were a par provider, you could not collect per your signed contract with cigna to collect deductibles and coinsurance prior to obtaining the EOB.

Charlene
February 1, 2009 @ 1:52 PM Reply  |  Email Friend   |  |Print  |  Top

Michelle, you can collect the Medicare deductible upfront.

Oceabrz
February 1, 2009 @ 3:27 PM Reply  |  Email Friend   |  |Print  |  Top

Yes, I do know that we can collect the Medicare deductible upfront, and I don't see why we wouldn't be able to collect others upfront, unless as you stated, it's a contract provision.

Thanks!  Oh yeah, I have many a debate with insurance reps over many things!  I know how frustrating they can be

Oceabrz
February 1, 2009 @ 9:48 PM Reply  |  Email Friend   |  |Print  |  Top

When I worked for the Cardiologist back in the late 1990's, we used to collect it and then refund if necessary if Medicare applied it to another provider

CLARE
February 2, 2009 @ 11:15 AM Reply  |  Email Friend   |  |Print  |  Top

We are a contracted provider from Illinois I lot of our patients have anual deductibles We usually ask for $50 towards their visit when they have a deductible of between $300 and $1000 We are not asking for the full amount of the visit we usually ask for less the insurance contacted amount. We also was told by the insurance company that we cannot not do this but we think we can The insurance company always want their insurance premiums upfront before they will cover a patient
so why can't we ask for a downpayment

Charlene
February 6, 2009 @ 8:59 PM Reply  |  Email Friend   |  |Print  |  Top

If you look at the cigna website it states it clearly that a CONTRACTED provider can not collect deductibles, nor coins from a patient up front. You have to wait for the EOB. I tried to post the link, but the website won't allow it.

Laurie-Lynn M Soares
March 17, 2017 @ 9:43 AM Reply  |  Email Friend   |  |Print  |  Top

I agree with you 100% here, from a patient and Managerial point of view. I would like to add there are people taking this to another level, and not seeing the patient if they are unable to pay the deductible at the time of service. From an ethical and moral stand point, no one should be turned away for their inability to pay at that time. I've heard horror stories about this and personally experienced this myself. I'm a medical business office professional, was at the end of my pay period ending, and just didnt have the funds at the time I was sick. I had a medical facility REFUSE TO SEE ME even when explaining I get paid in a few days to settle the account. I was astonished at the ignorance of the office staff as well as the supervisor of the facility. This happened once before when scheduling an appointment. The sad part is the medical providers are unaware at times how the front office is affecting their business with this approach.

Nicole
July 12, 2018 @ 10:41 AM Reply  |  Email Friend   |  |Print  |  Top

Hi Oceabrz! I work for a company that offers a technology to get payment assurance at the time of visit, while the patient is in your office, to collect the payment after the claim has been processed by the insurance company. This guarantees payment for your office and eliminates the need to send refund checks. We can also create an EOB for the patient at any time. The company is Health iPass.

steve verno
February 1, 2009 @ 4:54 PM Reply  |  Email Friend   |  |Print  |  Top

Medicare General Information, Eligibility, and Entitlement
Chapter 3 - Deductibles, Coinsurance Amounts, and Payment Limitations
20.2 - Part B Annual Deductible
(Rev. 56; Issued: 11-17-08; Effective Date: 01-01-09; Implementation Date: 01-05-09)
In each calendar year, a cash deductible must be satisfied before payment can be made under SMI. (See 20.4 of this chapter for exceptions.)
"
For 2009, and until further notice, the deductible remains $135.
"
For 2008, the deductible is $135.

Expenses count toward the deductible on the basis of incurred, rather than paid expenses, and are based on Medicare allowed amounts. Non-covered expenses do not count toward the deductible. Even though an individual is not entitled to Part B benefits for the entire calendar year (i.e., insurance coverage begins after the first month of a year or the individual dies before the last month of the year), he or she is still subject to the full deductible for that year. Medical expenses incurred in the portion of the year preceding entitlement to medical insurance are not credited toward the deductible.
The date of service generally determines when expenses were incurred, but expenses are allocated to the deductible in the order in which the bills are received. Services not subject to the deductible cannot be used to satisfy the deductible.

the above is from CMS. As you can see, nothing prohibits the provider from collecting the deducible at the time of service.

Now, Ive had people tell me that you cant and when I say show me, they cant.

steve verno
February 1, 2009 @ 4:54 PM Reply  |  Email Friend   |  |Print  |  Top

Medicare General Information, Eligibility, and Entitlement
Chapter 3 - Deductibles, Coinsurance Amounts, and Payment Limitations
20.2 - Part B Annual Deductible
(Rev. 56; Issued: 11-17-08; Effective Date: 01-01-09; Implementation Date: 01-05-09)
In each calendar year, a cash deductible must be satisfied before payment can be made under SMI. (See 20.4 of this chapter for exceptions.)
"
For 2009, and until further notice, the deductible remains $135.
"
For 2008, the deductible is $135.

Expenses count toward the deductible on the basis of incurred, rather than paid expenses, and are based on Medicare allowed amounts. Non-covered expenses do not count toward the deductible. Even though an individual is not entitled to Part B benefits for the entire calendar year (i.e., insurance coverage begins after the first month of a year or the individual dies before the last month of the year), he or she is still subject to the full deductible for that year. Medical expenses incurred in the portion of the year preceding entitlement to medical insurance are not credited toward the deductible.
The date of service generally determines when expenses were incurred, but expenses are allocated to the deductible in the order in which the bills are received. Services not subject to the deductible cannot be used to satisfy the deductible.

the above is from CMS. As you can see, nothing prohibits the provider from collecting the deducible at the time of service.

Now, Ive had people tell me that you cant and when I say show me, they cant.



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