02/10/2015    Michael M. Rosenblatt, DPM

Handling Patients with High Deductibles Who Refuse to Pay (Alan Bloch, DPM)

Dr. Alan Bloch wrote that he had a patient with a
3,000 dollar deductible who was reluctant to
charge a hundred dollar "good faith" payment for
his first office call, but eventually did. The
patient subsequently called his insurance company
and was told that "it was not customary" to be
charged an up-front billing by a doctor. The
patient is now seeking to remove the payment.

Dr. Bloch asked an interesting question about the
Advance Beneficiary Notice Form. He posits that if
the patient signed the form, the patient is
"acknowledging" by signature that he/she is
responsible for it if the insurance refuses to pay
it. I don't know if an ABN form would be
applicable to a non-Medicare situation. But I
suppose one could create your own "ABN" to be
generally applicable to every patient. Dr. Bloch
suggests that such a form could be used as "proof"
that the patient recognizes their own financial
responsibility.

Even if such a form were successful in some cases,
a patient who refuses to pay you will not change
their stripes any time soon. This is a red-flag.
Any physician who sees a red-flag patient has been
given a gift by that patient. The physician now
knows for sure that not only will they not get
paid, but also the patient has a very strong
likelihood of suing.

I would also dispute the insurance companies'
statement about up-front charges. Virtually every
private practice doctor and dentist I have ever
seen has a notice in their office that "payment is
due at time services are rendered." Kaiser will
not permit you to receive any services until you
pay your co-insurance at their entry kiosks.
Kaiser also demands payment at their ER at time of
service.

It is likely that the patient will "bad mouth" you
to their friends and relatives. Personally, I'd
rather that then have to report another claim to
my malpractice carrier.

Michael M. Rosenblatt, DPM, (Retired), San Jose,
CA

Other messages in this thread:

---

02/11/2015    Paul Kesselman, DPM

Handling Patients with High Deductibles Who Refuse to Pay (Alan Bloch, DPM)

Any patient who protests about paying their
deductible and co-pays is not worth having as a
patient. You may want to check your contract with
the third-party payer as there may be nothing
wrong with collecting something from
the patient as a "down payment" on their
deductible.

Anyone who has such a high deductible ($3K) and
has not met any of it, certainly is going to have
to pay something. If you have the fee schedule, it
is certainly much easier to provide some estimate
as to what they are owed.

As for the CSR telling the patient they should not
pay anything until the claim is processed,
remember who the CSR is. They are usually entry
level personnel and are told what to say to
"please" the insured. They are not there to
satisfy the physician or any other provider.
Many insurance companies have their own version of
an ABN which can be used to formally inform the
patient that they are responsible for paying for
any specific services which are non covered, or
any deductibles and co-pays.

The collection agency my office has employed
provided us with an outline for a financial policy
form which we have adopted. This formal financial
policy is provided to each patient during their
intake and we require all new patients to sign
(established patients w/o one are also required to
sign one).

These two tools inform the patients of their
financial responsibility should claims be denied
because of "lack of medical necessity", deposits
for non covered services or DME, deductibles and
co-pays. In addition, it informs the patient they
are responsible for paying any collection agency
fees.

If you were to show provide these documents to the
credit card company it would strengthen your case
and lessen your chances of having these
charges withdrawn from your account.

In the long run, be glad to you didn't get too
involved with this type of patient who claims they
couldn't afford your services after only incurring
$100 in services.

You don't need to be filling up your appointment
book with these types of patients.

Paul Kesselman, DPM, Woodside NY