The world of high-deductible insurance – where you may pay a higher rate than the uninsured:

Case in point: Lisa Stamm of Kendall, who had a simple earache and got slapped with a $375 bill for about 10 minutes with a nurse practitioner. If she had no insurance, she could have paid $125. If she had a no-deductible policy, her insurer might have paid about $140, and she would have paid nothing.

Expect this trend to continue. (via The Health Care Blog)

Update:
An upcoming problem for high-deductible insurances is that it will place the onus of collection on the physician. One way to combat this is to require all patients to give a credit card number:

So why not do what a growing number of businesses, including every hotel, motel, and country inn on the planet, already do: Ask each patient for a credit card, take an imprint, and bill balances to it as they accrue.

Geoff Anders, president of the Health Care Group Inc., suggested this in a talk that he gave at a recent meeting, and it hit me like the proverbial ““whack on the side of the head””: Why haven’t we all been doing this for years?

After all, patients think nothing of handing a credit card to a busboy in a restaurant, with little or no concern for what he might do with it in the kitchen. They blithely shoot credit card numbers into a black hole in the Internet. So why should they object to doing the same thing with their medical bills?

Beginning last January, every patient entering our office has been handed a letter at the check-in desk explaining our new policy of asking for a credit card number on which any outstanding balances will be billed. (See box below.) At the bottom of the letter is a brief consent for the patient to sign, and a place to write the credit card number and expiration date.

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  • NoAcuteDistress

    Imagine what the bill would be like if she were treated using the “Defensive Medicine Protocol”:
    Specialty referral, CT scan, pre and post treatment audiograms and follow-up specialty visit.

  • Anonymous

    I pay $112 a month for a Fortis policy with a $2,500 deductible. It’s considered a “temporary” plan — I have to have it rewritten every 12 months, and anything I’ve been treated for is considered preexisting. I carry it in the case of a major medical emergency, and since I’ve become s self-employed it’s all I can afford. It doesn’t qualify as a HSA — those are more expensive. I’m learning that it’s better to tell health care providers that I have NO insurance. Last week I went in for a level III exam for shoulder pain that had lasted over 5 weeks. The practice gives a 20% discount when a bill is paid in full at the time of visit, but only UNINSURED patients get the discount. When I protested that that I was paying in full, I was told it would be insurance fraud to give me the discount, despite the fact that the visit wouldn’t be covered by Fortis, or even submitted to them. Worse yet, after spending 5 minutes with me the Doctor told me bones and muscles weren’t her “thing,” so she referred me somewhere else, so basically I was paying $148 for her to write a referral.

  • Kevin

    There are going to be plenty of stories of “sticker shock” as high-deductible insurance force the public to realize the cost of medical care.

    Kevin

  • Anonymous

    No sympathy for the lady in the article.

    A.) It is her job to make sure that the places she visits are “in-network” with her insurance company. She obviously didn’t call and check first. If she had, she would only owe the $125.

    B.) She said she “figured” it would take a few days to see her PCP– so obviously she didn’t even try calling first to see. Its not always the case that you can get a same or next day visit, but it is the majority of the time. More likely, she just wanted to convenience of being able to go to a walk-in center on her lunch or after work.

    I do however think that the billing code is fraudulent. She should contest that. Most urgent cares around here bill starting at $75 for something like that and may max out at $200-$300 for very extensive workups.

  • Anonymous

    I;m having a hard time figuring out the point of this anecdote, because it seems to be making several points at once: patient’s financial responsibility, network vs. out of network charges, ED vs urgent care charges, arcane pricing structure, etc. etc.

    Discount or no discount, $375 does seem excessive for a brief visit with a mid-level practitioner.

    Kevin, I think there’s going to be more than just sticker shock. It’s going to get harder and harder to collect payment for services rendered. You’re going to see more people taking longer to pay off their bill and paying it in little bitty increments because that’s all they can afford. You’ll probably see more patients defaulting on their bill. Get ready for it.

  • dn

    Read the article. It cost $375 because she was a deadbeat who didn’t pay for four months.

  • Anonymous

    dn, the article said she wasn’t billed until four months later. And I didn’t see any indication that the $375 included some kind of penalty for paying late.

    I certainly think it’s OK for providers to charge interest once a bill goes uncollected past a specified time limit. But first you have to get the bill into the patient’s hands. A four-month wait suggests to me the clinic’s billing practices are inefficient.

  • Anonymous

    “A four-month wait suggests to me the clinic’s billing practices are inefficient.”

    Indeed. The clinic should have known they didn’t participate with Cinga and told her to settle up with the front desk before she left.

    As for the “we can’t give a discount ’cause that’s insurance fraud” mantra, it’s complete BS. Charge your $375, have the patient sign a debt settlement agreement for $75 and write off the rest of it. If you want to be all legitimate about it, hand her a 1099C while you’re at it.

    100% of $75 is worth a lot more than 100% of nothing.

  • Anonymous

    “Kevin, I think there’s going to be more than just sticker shock. It’s going to get harder and harder to collect payment for services rendered. You’re going to see more people taking longer to pay off their bill and paying it in little bitty increments because that’s all they can afford. You’ll probably see more patients defaulting on their bill. Get ready for it.”

    And get ready for a higher expected level of service from those who do.

  • Anonymous

    I am very interested in the credit card aspect of this post. Has anyone in the real world tried this? Sounds like a great idea…

  • Anonymous

    I’m aware of practices that take payment by credit card, but it’s generally presented as an option for method of payment once the bill is sent out; I don’t believe they ask for a credit card up front.

    I can foresee problems with asking everyone up front for a credit card. Not all patients will have a major credit card, and some will probably balk at handing it over. Among those who do have a credit card, you can figure that a fair percentage will be close to their credit limit or maxed out. So you’ll still need to find a way to collect from these folks.

    My veterinarian recently signed a contract with a third-party vendor for administering payment plans. If someone doesn’t have the cash for their pet’s veterinary care, they sign an agreement with the vendor to pay the cost in installments. The vendor then pays the vet the full amount up front and recoups the money through the client’s monthly payments. The financial incentive for the vendor is the monthly administrative fee paid by the veterinary practice, plus interest paid by the client. It’s an interesting model and might be worth looking into.

  • Anonymous

    Ten years ago when I was in the military I moonlighted at an urgent care/work comp/primary care type of clinic. They accepted payment by Visa, Mastercard, American Express and had them on prominent display at the check in. I don’t recall any problem or complaints with it.

  • Anonymous

    The majority of patients probably won’t mind.

    It should be an option, though, not a requirement. In the article Kevin posted, it sounded like the guy wanted to get credit card numbers up front from all his patients and then bill as the charges accrue.