Leave time to stop by the ATM before your next visit to the doctor. These days, you may have to fork over a lot more than just the co-pay before you leave the office.
A growing number of physician practices are using software programs, some developed by health insurance companies, that can immediately access a patient's insurance information and let the patient and the medical practice know precise co-pay rates, whether a deductible has been paid up and the exact or estimated dollar amount the insurer will pay once the doctor's office submits the bill. Armed with this information, often referred to as "real time claims adjudication," office managers can, and sometimes do, ask patients to pay those costs at the time of service.
"At this time of year, when few people have yet to pay off their deductible, patients who go into the doctor's office packing a $10 or $20 bill to pay the co-pay may be surprised when they're handed a bill sporting a far higher number," says Marc Halley, president and chief executive of Halley Consulting Group of Columbus, Ohio, a physician practice management firm with clients in several states.
Kati Spencer, 39, a public relations executive in Tempe, Ariz., recently visited a medical center in Scottsdale for a cortisone shot to relieve pain in her hip. The hospital determined that Spencer's $2,600 deductible had not yet been met and asked for full payment of the $2,000 fee for the injection. (In the end, the hospital accepted a 10% deposit and sent the bill to Spencer's insurer to see what share it might yet pay.)
From a doctor's financial perspective, such moves make sense. Just as the economy is affecting other industries and individuals, it's also affecting physicians trying to meet their overhead and administrative costs. "Being more fiscally efficient and proactive may be the only way they can stay open and continue to see patients," says Jeffrey Luther, president of the California Academy of Family Physicians and associate director of the family medicine residency program at Long Beach Memorial Medical Center.
About 13% of physician revenue comes from patients themselves, not insurers, says Mark Rukavina, executive director of the Access Project, a health insurance resource group in Boston. Adds Halley, that's likely to rise as more consumers opt for lower-premium, but higher-deductible insurance plans -- requiring consumers to pay out hundreds to thousands of dollars before insurance kicks in.
