Patient Copays: To Bill or Not to Bill?

Blog | May 12, 2013 | By Rebecca Fox, MD

Imagine this scenario: A man walks into a coffeehouse and orders a large vanilla latte and a muffin. The barista immediately starts working on his coffee. The man tells the cashier, "I forgot my wallet. Can you just send me the bill for this?" The cashier looks at him with incredulous eyes.

Sound ridiculous? It happens all the time in my medical practice, especially for the dreaded copay.

Most patients are compliant with paying the copay cost. At the beginning of the new year, they usually seem to even know when their copay amount has changed. But we do have people that tell us just what was said in the above vignette, and more, including:

• "My husband/wife has the credit card or usually takes care of this."

• "My purse is in the car."

• "Can you just bill me?"

Seriously?!?

I think patients sometimes forget that we are a business and we have bills and payroll that we must pay. But according to each patient’s insurance company, patients have their own responsibilities, especially when it comes to copays.

The gradual phase-in of healthcare reform has caused a great deal of confusion over what type of visit has a copay and which doesn’t. Physical exams (well-child care) usually don’t have an out-of-pocket expense for the patient, but regular office visits and follow up appointments do have a copay associated with them. It’s easy for patients to get confused and possibly frustrated because they might not understand why one office visit will have an out-of-pocket fee while another (seemingly similar) visit does not.

So …what can be done?

We have instituted several changes that have helped. First, we ask for the copay at check-in before seeing the patient for those that have a copay. (Obviously, for those patients with an 80/20 plan or no insurance, the charge will vary depending on the level of service. This is handled later in the visit.)

If we must bill the copay, we tack on a $5 service charge to defray the labor cost involved in generating this bill and to encourage the patient to pay the copay up front in the future . Another tactic that has worked for us is to transfer any credit that may be on another family member’s account for the current day’s visit. Finally, for those patients who lack health insurance, we offer a discount if the bill is paid in cash on the same day of service. (After all, we are in pediatrics and I feel really bad about the kids without health insurance.)

Copays are a fraction of the total bill for an average office visit. Even so, these small amounts can really add up. Make sure your front desk is diligent about collecting these payments on the day of service.

And enjoy your latte!

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Source URL: http://www.physicianspractice.com/patient-copays-to-bill-or-not-to-bill

One-third of physician practices do not accept credit card payments

May 29, 2009 | Richard Pizzi, Editor | Healthcare Finance News

IRVINE, CA –

Thirty-three percent of physician offices do not accept credit cards as a form of payment, according to a new survey. This represents a 5 percent increase since a similar survey was conducted last year.

The Physician Office Credit-Card Acceptance Survey, by SK&A Information Services, an Irvine, Calif.-based provider of healthcare information solutions and research, suggests physician practices are limiting this form of payment because patients are being adversely affected by high interest rates, maxed out credit limits and a more challenging ability to qualify for credit.

“Since the U.S. credit crisis exploded last year, creditors have become synonymous with excessive rate and fee increases, and we’re seeing the effects of that in the latest Physician Office Credit-Card Acceptance Survey,” said Dave Escalante, president and CEO of SK&A. “Fewer patients are able to use their credit cards at doctor offices because of the worsening consumer credit situation.”

Escalante said the survey, when segmented by physician-office specialty, indicates offices that specialize in elective or cosmetic procedures – which typically don’t bill insurance companies – are more likely to accept credit cards.

The offices that accept credit cards most often are those of plastic surgeons, with a 91 percent acceptance rate, while pathology offices accept them the least, with a 21 percent acceptance rate.

Other specialties with high acceptance rates are:

• Ophthalmology (84 percent)
• Bariatrics (83 percent)
• Otolaryngology (83 percent)
• Dermatology (81 percent)

Specialties with low acceptance rates include:

• Dialysis (27 percent)
• Geriatric medicine (32 percent)
• Nuclear medicine (35 percent)
• Critical-care medicine (37 percent)

Of those offices who accept credit cards, 66 percent take either MasterCard or Visa. The least accepted credit card is American Express, at 27.7 percent. “The recently passed Credit Cardholders Bill of Rights Act of 2009 will lead consumers from misleading contract language and unfair rate and fee increases, which should invigorate consumer credit spending,” said Escalante. “Our report can be used to compare current and past credit spending and physician credit-card acceptance rates. It will be interesting to see how the new law will affect next year’s physician credit-card acceptance rates.

Results of the Physician Office Credit-Card Acceptance Survey are based on telephone surveys with 202,650 physician offices nationwide completed in April 2009.

Photo by Andreas Rueda obtained under Creative Commons license.

More ways to help manage medical costs

By

updated 1:13 p.m. ET Feb. 10, 2009

Patients have several tools to help manage medical costs. Here are some additional tips recommended by debt reduction experts.

_ Talk to the doctor about whether all the recommended care is necessary.

_ Ask if a procedure can be done on an outpatient basis, to avoid a costly hospital stay.

_ Can you use less-expensive, generic versions of the medicine you need?

_ Avoid using your credit card. If you pay it all off with that, you lose leverage with the hospital and you may have to pay high interest.

_ Remember your manners. Billing office representatives know how the system works and may be helpful if you don't yell at them.

_ Go beyond the billing office. People with higher levels of authority sometimes can approve larger discounts.

_ Talk to the doctor. A physician may show more sympathy than a billing clerk who hears customer complaints every day.

_ Check in-network coverage. Make sure your doctor, the anesthesiologist and everyone else caring for you is in your insurance network.

_ Document everything. Keep a record of phone conversations and all paperwork so you can show what you were told, by whom and when.

Copyright 2009 The Associated Press. All rights reserved.