Physicians Increasingly Require Patients To Pay Fees At Time Of Service

Main Category: Medical Practice Management
Also Included In: Health Insurance / Medical Insurance;  Primary Care / General Practice
Article Date: 04 Mar 2009 - 6:00 PDT

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The Washington Post on Tuesday examined how physicians are increasingly requiring patients to pay their portion of service fees, including deductibles and copayments, at the time of the visit. According to Red Gillen, a San Francisco-based analyst with consulting firm Celent, until recently, physicians focused their fee recovery efforts on insurers, who paid the majority of medical costs. However, as employers and health insurers increasingly shift costs to consumers in the form of higher deductibles and copays, those fees comprise a larger portion of physicians' incomes, Gillen said.

He said, "Until now insured patients would see a doctor, leave a copay and then watch a series of insurance and physician envelopes come through the mail over weeks to months, until finally one detailed the actual amount, if any, to be paid by the patient." The Post reports, "Now, largely through new software programs that assess both a patient's insurance coverage and the day's charges, those weeks to months are often collapsed into just minutes for an estimate, or even a full adjudication of the bill." Gillen said, "It's a paradigm shift from what most consumers are used to at their doctor's office."

A number of insurers -- including some BlueCross BlueShield plans, Cigna, Humana and UnitedHealthcare -- already have implemented or plan to implement such software. Lori Logan, head of new products for Cigna, said, "Most firms rely on estimates, rather than definitive bills, because there could be additional charges related to the visit that can't be anticipated, such as an extra lab test on a biopsy, for example, and there can be a lag in communicating deductible payments between other physicians and the insurer." Washington Hospital Center spokesperson Paula Faria said, "This combined information is gathered prior to preregistration and is presented to the patient," and "once a patient has a clear idea of what their coverage will cover and what their cost will be, a meeting with our financial counseling office is arranged" (Lunzer Kritz, Washington Post, 3/3).

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