I think the answer to this question is "NO!", but I'll run it past you folks. We've been getting a few patients over the last couple of weeks that say their insurance pays so much that they aren't supposed to pay their copay. Another one we're hearing is " I've met my deductible so I don't have to pay my copay". I've never heard of anything like this before. Have you?
I would agree with you. The way I understand it, only deductibles and coinsurance count towards the Maximum Out of Pocket amounts. One thing you can check is whether any of these insurances have a method that you can submit an estimate of services (which will generally give you a copay amount) for those you really want to argue. Aetna(through Navinet) and UHC (through Unitedhealthcareonline.com) being 2 that I can always get estimates on.
As a patient, when I use my Medicare and Anthem BC/BS here in Oregon for medical care my physicians office sends a bill to the insurance carriers on my behalf. If any co-pay is due I get a bill and I pay it. I certainly don't expect Flossy at the front desk of the doctors office to have to figure out any billing issues as the poor girl has only been on the job for two days and can hardly remember where she put her lunch.
What could be simpler. My deductible is an issue between me and my insurer.
Last edited by rbaker; 06-10-2015 at 12:11 PM.
Firstly, it would help to know if you and your patient are talking about medical or optical insurance.Originally Posted by EyeSore
Secondly, it sounds like your patient is talking optical and he/she thinks you are making so many millions, that you should be grateful just to have him walk in the door and not have him pay his fair share. If this is the case, set him straight.
"Optical insurance" ain't insurance. It's some sort of prepaid scheme and most likely not regulated under the same rules by your State Insurance Commission. "Optical insurance" proves what P.T. Barnum stated many ears ago, "there's a sucker born every minute" and further expressed by W.C. Fields "never give a sucker an even break."
The "suckers" are equally distributed between patients and providers! There I said it.
Thanks for every ones responses. rbaker, As far as being a sucker, I'm starting to feel that way every time I open a EOB.
Happens with medical insurance.
Another glowing example of why independents should continually look at ways to wean themselves off of any and all plans like this - insurance, vision or otherwise. The headaches are rarely worth the "rewards". You don't have to drop everything tomorrow, but make moves to reduce the interaction with those plans over time to zero.
Some medical plans do have a maximum out of pocket amount for patient/family. However this information should be available if you are doing a prior look up of some sort.
For our high deductible patients we give them two choices: We can submit to your insurance, wait for them to notify us of your deductible, and then bill you in full for your exam and refraction. Or, we can simply give you our prompt payment (same day as service) discount and you would only owe use X today. (Saves $45). We have many that opt to save, and pay in full today :)
"Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland
Here in Mass, Blue Cross of Mass has no copay on routine vision every 2 years. Some other plans similar, the same as pregnant women not having copays for pre-natal care.
We always verify insurance with a print out. Again, sometimes the vision exam is exempt from copay and deductible.
Harry
Unless that doc wants to actually see the money. Patients are HORRIBLE about paying their co-pays after they leave the office. Also, it becomes pretty expensive to send out that many $20-$40 bills every month. It costs much less to verify insurance in advance and collect the deductible (and also refraction fee if applicable) while you have that Rx still in the chart and not in the patient's hand. That might come off as rude and money grubbing but you can do it very tactfully.
Agreed +1
There are certain plans that have a maximum out-of-pocket expense per year, including copays and deductibles.
It sure would be nice to know which ones.
It's hard work, but you have to get on each insurance's website for each patient in advance.
The problem in our field is that we don't often know whether it's a vision or medical visit.
Well, you know your clientele better than anyone. As I never worked with these so-called "vision plans" I cant address these billing issues. Here in Oregon Medicare and Asuris BC&BS co-pays don't seem to be an issue with the providers. I guess their billing software takes the drudgery out of the equation.
I also wonder how you know what my co-pay is going to be prior to billing my insurer.
[What could be simpler. My deductible is an issue between me and my insurer.[/QUOTE]
Oh but Mr Baker. Come the first of the year most no one has reached their deductible. Our office HAS to collect the deductible from you because YOUR insurance is going to deduct that amount from whatever they are to reimburse our office for our services. If we do not collect then we have short changed ourselves.
Its the insurances way of paying as little as they can get away with and forcing the office to be looked at as the bad guy.
"Oh but Mr Baker. Come the first of the year most no one has reached their deductible. Our office HAS to collect the deductible from you because YOUR insurance is going to deduct that amount from whatever they are to reimburse our office for our services. If we do not collect then we have short changed ourselves.
Its the insurances way of paying as little as they can get away with and forcing the office to be looked at as the bad guy.'
I'm 75 years old and suffer from DBD (Degenerative Body Disease) and spend the majority of my day, when not on OptiBoard, in the offices of my Primary Care Quack, Cardiologist, Endocrinologist, Gastroenterologist, Orthopedic Surgeon, Ophthalmologist, Physical Therapist, Elliot Ness and the Untouchables and all the Kings Horses and all the Kings men. SO far this year I have spent 26 days in the hospital.
Not once have I been asked for a co-pay or anything concerning my deductible. Some time after a procedure I get a bill for any co-pay or non covered item. I pay the bill. I can understand you wanting to get every penny from my pocket to yours but, my friend, my insurance provider is the gate keeper between the both of us. Personally, I trust them. not you.
Last edited by rbaker; 06-17-2015 at 04:58 PM.
Well...
...nevermind.
Often when a patient has medicare and a supplement, we will wait till all payers have paid, then bill the patient unless we know that the specific item/service is non covered (such as refraction.)
However, when I go onto my insurance website to verify eligibility (Gateway,Availity) if I select physician in office visit, I can get a copay on most plans if I have your insurance ID. I can also go in and check the deductible, if met deductible, etc.. and use that to guide us in offering our "prompt payment" discount to those who have high deductible plans.
By the way.. I just had a cervical fusion done (2 level ACDF) and I HAD to pay my surgical copays upfront. They got an estimate of services, said my portion was X, and had me prepay. This was their financial policy. They did have payment plans though. Of course, we are talking thousands and not $20 here and $50 there.
"Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland
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