Sunday, February 1, 2009

Seeing the Doctor? Bring your Credit Card

The days of the $5 or $10 copay are leaving fast. A growing number of doctors offices are now using software programs that can tell them exactly if a deductible has been paid and what the patient needs to pay at the time of the visit. Most insurance now has a large deductible..even as much as $2500 to $5000 a year. Many healthy patients don't even meet their deductible in a year so they are responsible for first dollar payment.

From the doctor's perspective, collecting this money at the time of service is good business sense. The good old days where the doctor was paid last, is long gone with primary care and even general surgery doctors closing their doors because of financial issues. The margins are very thin in many medical offices and as practice expenses rise, the need to collect at the time of service is critical.

"Bill my insurance" is a term that is going by the wayside. Since "Bill my insurance" actually means the doctor will send several bills over several months and maybe 4 months later will receive a statement from the insurance company that says the amount billed is $135...the amount allowed is $62...and the patient has not yet completed the deductible so the payment is $0.

It costs a medical practice between 6-10% to send bills. The practice has just lost money on seeing that patient and in some practices 30% go unpaid.

It is no wonder physicians are being forced to be more businesslike and collect at the time of service. But it is painful for patients who have always layed down a $5 bill and they think this is the cost of medical care.

When patients pay out of pocket they do become better at deciding if they really need that test. They also realize up front what a rip off their insurance is. (don't get me started on the health insurance biz). I've said before that most "screening" blood tests are wasteful. Patients are now finding out just how expensive they are too, as they pay a larger part of the actual cost of care.

Now we need to get to the place where patients can find out AHEAD of time what the cost will be. You wouldn't dine in a restaurant without knowing the menu price. Patients shouldn't be forced to receive medical service or tests without knowing the menu price either. That would be one way to bring costs into line.


Kellie said...

I was sick in Paris a few months ago and went to the doctor. At the end of the exam the doctor takes you to her office where she is sitting at her desk and she actually was the one who gave the bill and recieved the cash.

Before leaving the US I had asked a friend
who is French and lived in Paris what seeing a physician costs in France, in case of geting sick there. France prices of a visit are much less then ours but they have socialized medicine.

The same trip in Amsterdam I was with someone who was sick on the weekend and had to go to the ER and they said he would be billed even though he was from the US. He recieved a bill 2 months later.

Healthnut said...

It makes sense. If the economy continues to be stagnant, there is no telling what can happen to some insurance carriers. These days insurance carriers are receiving less premiums in revenue (less enrollment) and less return on their investment.

While banks and investment firms are making headlines, one has to wonder just how secure are some of these insurance carriers are. We've already seen AIG's mess.

Toni Brayer MD said...

Healthnut: I have no worries about insurance conglomerates. They had been posting record profits and the CEOs are bonused in the hundred millions. They are way ahead of the rest of society in creating new underwriting, insurance products and denials of claims. AIG failed because of the unusual investment/financial products it owned. Of course, the stock crash has hurt insurance companies, like everyone else.

I am not sure what "investment" health insurance companies have. From what I can see...they take in money, invest it and pay out a portion in claims. It is a money new goods are produced.

Catherine D said...

Guess it's time to move to Canada, We go to a doctor or a hospital and never get billed. We would love to be living in America but your health care is one of the things that kepp us up here

Joe said...

"Now we need to get to the place where patients can find out AHEAD of time what the cost will be."

Thanks, Dr. Toni!

I can't be certain, but anecdotal evidence suggests that you are the only doctor in the country who understands this issue.

"Huh? Oh, I don't know what this will cost. You need to ask your insurance company" is the answer I most often get, usually accompanied by a surprised look. said...

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