High-Deductible, Low-Premium Plans Leave Physicians Trying to Collect from Patients

According to a recent article, the emerging popularity of low-premium, high-deductible health insurance plans that hold patients responsible for a greater share of their medical expenses is taking its toll on both physicians and patients. In the article, a practice manager in Pittsburgh said that patients very rarely understand their deductibles, copays, and coinsurance. This can lead to unpaid balances.

So, what happens when a patient has a past due balance? The patient can become frustrated, especially if he or she simply cannot afford the payment. The physician, who needs the revenue to sustain practice operations, also can become frustrated. It’s not just practice operations. The physician provided a service and deserves to be paid for it. This can negatively affect the physician-patient relationship.

Physicians and practice managers often ask the Pennsylvania Medical Society (PAMED) for advice on strategies to utilize when collecting unpaid balances from patients.

Here are some tips:

  • Clearly communicate financial policies and procedures with patients. When communicated clearly and respectfully to patients, these processes may also help avoid negative impacts on the physician-patient relationship and damage to the practice and/or physician’s reputation.
  • Implement a solid financial and billing policy detailing their expectations for charging, billing, and collection of accounts receivable.
  • Educate patients, especially new patients, on their financial responsibilities and on their billing policies and procedures. This will encourage them to comply. Some examples are office brochures, welcome letters, and websites. The information should include the insurance companies the practice participates with, policies for collecting co-payments, deductibles, co-insurances, as well as payments for non-covered services. Information should also be included on the practice’s process for filing claims, credit cards that are accepted, the process and timing for sending out patient statements, when payment is due, and the policy for turning balances over to a collection agency. Make sure they understand their financial responsibilities—such as copays, deductibles, and coinsurance—before the office visit.
  • Consider payment plans. The patient may be more inclined to make a payment or pay the balance if this option is available to them.
  • Review financial policies annually, especially due to the ever-changing rules of private and public health insurance carriers.
  • Ensure that office staff is fully knowledgeable of the policies and procedures, as well as any changes which may be made to the financial policy.
  • Train front office staff to double-check for past due balances on the patient account and consider reminding the patients of such balance.

Tool You Can Use: PAMED’s Collections Protocols for the Medical Practice, free for members as a downloadable PDF, provides information on managing collection of payments from patients with traditional health insurance policies and with high-deductible consumer-directed health plans, including Health Savings Accounts and Health Reimbursement Accounts, as well as the new plans sold in the federally-facilitated health insurance marketplace.