Guest guest Posted October 16, 2007 Report Share Posted October 16, 2007 This topic prompted me to ask my staff how well we do with collecting co-pays-we get 95% plus of co-pays-it is understood that this is the patient's responsibility to pay and our responsibility to collect. (This is irreregardless of my feelings about the overall system) After discussions with LL I know he has a sense that people should have a sense of individual responsibility in this world we live in. Although I don't always walk the walk, I'm inclined to agree with him. > I realize that I am committing a major sin of heresy here, but..... > > Has anyone besides me concluded that collecting copays prior to the visit is just about more trouble than it is worth? > > I know, I know...that's cashflow, and we are told that the bottom line will be better if we do that...but... > > It slows things down getting the patient into the room > It means I have to keep running to the bank to get change, and I have to keep cash in the office overnight > I don't take credit or debit cards, and keep thinking I will have to, at additional cost to me, because patients don't carry cash or checks > The majority of my patients now STILL end up having to be billed for deductible, co-insurance and non-covered stuff, even if they paid the copay at the time of the visit, so it doesn't prevent having to send a bill > Many insurance cards don't state the copay amount and most of those patients don't know what it is supposed to be > High deductible plans say " there is a $30 copay after the $1500 deductible is met " , but we're not supposed to collect the $30 until then > I have been having to waste time every month writing refund checks (usually 6-15 per month) because we collected too much somewhere along the line > So, more and more I keep thinking that it would save me enough in time and efficiencyto be worth just skipping the copay collection and bill for the whole patient portion after insurance responds. > > Go ahead and shoot me, but then tell me what you really think.... > > Annie > > > > > > > > > > > --------------------------------- > Don't let your dream ride pass you by. Make it a reality with Yahoo! Autos. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2007 Report Share Posted October 16, 2007 I have a credit card machine in the exam room. Takes about 30 seconds max & meanwhile the pt and I are talking about other things, schmoozing, etc. I collect copay after the visit. Gordon At 01:07 PM 10/16/2007, you wrote: copayments are part of the patient responsibility wrt the insurance contract. patients know this, and it's your responsibility to know it, too. they also know that it's due up front, and may be required in order to be seen. this is an insurance company device designed to divide and conquer; it's under the guise of " making the patient take responsibility for their care " ; it places a potential financial wedge between us and our patients, to prevent any alliance. in addition, higher copayments help to prevent patients from accessing care, which leads to lower insurance company payouts. an additional scenario goes, doctor, you knew that your patient had a critical medical condition, yet you failed to see the patient for further care, just because of a piddling $20 copay? to guard against this, document that you have informed the patient that they need to be seen, and refer them to a clinic where they can be seen irrespective of being able to afford and pay their copayment. it's still the patient's responsibility, and these copayments add up. if patients have difficulty with this, explain that when they go to supermarket, they're expected to pay when they buy their groceries. in the case of medical care, there may still be an additional amount they owe, after copayment and insurance payment. if they can't or won't understand that, they are free to seek care elsewhere. if their copayment amount is not on the insurance card, you can electronically check it, along with other insurance elgibility, on line. hope that's helpful. politically incorrect and heretical. LOLLL Annie Skaggs wrote: I realize that I am committing a major sin of heresy here, but..... Has anyone besides me concluded that collecting copays prior to the visit is just about more trouble than it is worth? I know, I know...that's cashflow, and we are told that the bottom line will be better if we do that...but... It slows things down getting the patient into the room It means I have to keep running to the bank to get change, and I have to keep cash in the office overnight I don't take credit or debit cards, and keep thinking I will have to, at additional cost to me, because patients don't carry cash or checks The majority of my patients now STILL end up having to be billed for deductible, co-insurance and non-covered stuff, even if they paid the copay at the time of the visit, so it doesn't prevent having to send a bill Many insurance cards don't state the copay amount and most of those patients don't know what it is supposed to be High deductible plans say " there is a $30 copay after the $1500 deductible is met " , but we're not supposed to collect the $30 until then I have been having to waste time every month writing refund checks (usually 6-15 per month) because we collected too much somewhere along the line So, more and more I keep thinking that it would save me enough in time and efficiencyto be worth just skipping the copay collection and bill for the whole patient portion after insurance responds. Go ahead and shoot me, but then tell me what you really think.... Annie Don't let your dream ride pass you by. Make it a reality with Yahoo! Autos. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2007 Report Share Posted October 16, 2007 Thanks for the responses. Just to clarify, I am not proposing not EVER collecting the copay, just delaying collecting it until we know what the entire patient responsibility is and billing it all at once. I know it is my responsibility to collect the copay amount, but I don't think my contracts say that I MUST collect them at the time of service, just that I must collect them. I agree with all the points about people taking some responsibility for the cost of their health care, and in general, the problem I bring up is not that patients are unwilling to pay thier copays. The problem is that it has become so cumbersome to do it at check in that I'm debating "bundling" copay collection into the billing on the backend. I think it was who said he likes to deposit the copays because he feels like he's making money, but most copays here are so low that I would never get a $200 deposit on copays alone. Most copays, if they are known up front, are still around $10 and many are $5 or even $4.50(hence the need to keep so much change..people keep wanting to pay a $4.50 copay with a $50 or $100 bill.) So, I'm thinking that if I just put up a sign that says "you will be billed for your portion of the cost of your visit" and eliminate the whole front end collection process it would save me at least an hour per day of time doing piddly stuff related to copays (trying to figure out what the amount should be, making change, writing a receipt, entering the amount on the deposit ticket, picking up change at the bank {which I can't do at the ATM when I make my deposit after hours}, refunding overcollection amounts, arguing with the habitual non-payers, etc, etc, etc) AND, the only cost to me (that I can think of) is a delay in getting those little bits of money until after insurance responds and the patient pays.... I guess maybe I should add up exactly how much money we are talking, but today was a really busy day and I still only got $75 in copay money. So I could bill the copays on the back end, wait 6 weeks for that $75 and use the "extra" hour to see two more patients which would bring in about $160.....I think I'm talking myself into this plan, but I'm still open to arguement. Annie L. Skaggs, MD Lexington, KY www.fayettefamilymed.com -----Original Message-----From: [mailto: ] On Behalf Of lawrence lyonSent: Tuesday, October 16, 2007 1:08 PMTo: Subject: collecting copayments copayments are part of the patient responsibility wrt the insurance contract. patients know this, and it's your responsibility to know it, too. they also know that it's due up front, and may be required in order to be seen. this is an insurance company device designed to divide and conquer; it's under the guise of "making the patient take responsibility for their care"; it places a potential financial wedge between us and our patients, to prevent any alliance. in addition, higher copayments help to prevent patients from accessing care, which leads to lower insurance company payouts. an additional scenario goes, doctor, you knew that your patient had a critical medical condition, yet you failed to see the patient for further care, just because of a piddling $20 copay? to guard against this, document that you have informed the patient that they need to be seen, and refer them to a clinic where they can be seen irrespective of being able to afford and pay their copayment. it's still the patient's responsibility, and these copayments add up. if patients have difficulty with this, explain that when they go to supermarket, they're expected to pay when they buy their groceries. in the case of medical care, there may still be an additional amount they owe, after copayment and insurance payment. if they can't or won't understand that, they are free to seek care elsewhere. if their copayment amount is not on the insurance card, you can electronically check it, along with other insurance elgibility, on line. hope that's helpful. politically incorrect and heretical. LOLLLAnnie Skaggs <askaggsfayettefamilymed> wrote: I realize that I am committing a major sin of heresy here, but..... Has anyone besides me concluded that collecting copays prior to the visit is just about more trouble than it is worth? I know, I know...that's cashflow, and we are told that the bottom line will be better if we do that...but... It slows things down getting the patient into the room It means I have to keep running to the bank to get change, and I have to keep cash in the office overnight I don't take credit or debit cards, and keep thinking I will have to, at additional cost to me, because patients don't carry cash or checks The majority of my patients now STILL end up having to be billed for deductible, co-insurance and non-covered stuff, even if they paid the copay at the time of the visit, so it doesn't prevent having to send a bill Many insurance cards don't state the copay amount and most of those patients don't know what it is supposed to be High deductible plans say "there is a $30 copay after the $1500 deductible is met", but we're not supposed to collect the $30 until then I have been having to waste time every month writing refund checks (usually 6-15 per month) because we collected too much somewhere along the line So, more and more I keep thinking that it would save me enough in time and efficiencyto be worth just skipping the copay collection and bill for the whole patient portion after insurance responds. Go ahead and shoot me, but then tell me what you really think.... Annie Don't let your dream ride pass you by. Make it a reality with Yahoo! Autos. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2007 Report Share Posted October 16, 2007 We collect co-pays at the time of service. (Mostly) I think a careful analysis of how many people need to be billed if you get the right co-pay is in order. If you end up billing 80% of patients for additional amounts, I would agree with your idea and bill it all later. But I think it costs us a minimum of about a buck to send out a statement (Envelope, Return Envelope ($.06) + Paper ($.01) + Toner ($.02) + Postage ($.041) = ($.50) + cost of assembling and mailing a statement). Plus a lot of people are slow in paying this way, sometimes taking a statement or two for a $20 copay. Almost all of our office visits are fully covered with a copay here. (I think some state law mandates that.) Co-insurance only applies to labs, procedures and about 5-10% of our insurance companies plus Medicare. So for us, collecting at the time of service saves us a buck or two. We also try to collect existing patient balances at the time of service if we can, saving us a buck or two, plus people tend to pay easier face to face. (They don’t shuffle the “rich doctor’s” bill to the bottom because you are standing in front of them.) We do take credit cards, which is convenient for copays, but critical for cash pay patients. We offer a 30% cash pay discount, which is cheaper than the interest on a credit card for a month or two. And we don’t have to wonder if they will eventually pay or not. Again saving us a buck or two at a minimum potentially the entire amount of the visit. Having said all that, if I regularly (70%+ of the time) had to bill the patient after having collected the copay, I would not bother either. Especially if the average copay was less than $10. But we don’t have any copays less than $10 here. Ernie Orchards Family Medicine, Inc. PS Billing & Office husband One doc owner, one doc employee, one MA, and me (when I show up:) Adding third employee doc in January Seeing 300 pt. a month Using e-MDs In 1200 sq ft Opened 8/2005 From: [mailto: ] On Behalf Of Annie Skaggs Sent: Tuesday, October 16, 2007 10:56 AM To: Subject: RE: collecting copayments Thanks for the responses. Just to clarify, I am not proposing not EVER collecting the copay, just delaying collecting it until we know what the entire patient responsibility is and billing it all at once. I know it is my responsibility to collect the copay amount, but I don't think my contracts say that I MUST collect them at the time of service, just that I must collect them. I agree with all the points about people taking some responsibility for the cost of their health care, and in general, the problem I bring up is not that patients are unwilling to pay thier copays. The problem is that it has become so cumbersome to do it at check in that I'm debating " bundling " copay collection into the billing on the backend. I think it was who said he likes to deposit the copays because he feels like he's making money, but most copays here are so low that I would never get a $200 deposit on copays alone. Most copays, if they are known up front, are still around $10 and many are $5 or even $4.50(hence the need to keep so much change..people keep wanting to pay a $4.50 copay with a $50 or $100 bill.) So, I'm thinking that if I just put up a sign that says " you will be billed for your portion of the cost of your visit " and eliminate the whole front end collection process it would save me at least an hour per day of time doing piddly stuff related to copays (trying to figure out what the amount should be, making change, writing a receipt, entering the amount on the deposit ticket, picking up change at the bank {which I can't do at the ATM when I make my deposit after hours}, refunding overcollection amounts, arguing with the habitual non-payers, etc, etc, etc) AND, the only cost to me (that I can think of) is a delay in getting those little bits of money until after insurance responds and the patient pays.... I guess maybe I should add up exactly how much money we are talking, but today was a really busy day and I still only got $75 in copay money. So I could bill the copays on the back end, wait 6 weeks for that $75 and use the " extra " hour to see two more patients which would bring in about $160.....I think I'm talking myself into this plan, but I'm still open to arguement. Annie L. Skaggs, MD Lexington, KY www.fayettefamilymed.com collecting copayments copayments are part of the patient responsibility wrt the insurance contract. patients know this, and it's your responsibility to know it, too. they also know that it's due up front, and may be required in order to be seen. this is an insurance company device designed to divide and conquer; it's under the guise of " making the patient take responsibility for their care " ; it places a potential financial wedge between us and our patients, to prevent any alliance. in addition, higher copayments help to prevent patients from accessing care, which leads to lower insurance company payouts. an additional scenario goes, doctor, you knew that your patient had a critical medical condition, yet you failed to see the patient for further care, just because of a piddling $20 copay? to guard against this, document that you have informed the patient that they need to be seen, and refer them to a clinic where they can be seen irrespective of being able to afford and pay their copayment. it's still the patient's responsibility, and these copayments add up. if patients have difficulty with this, explain that when they go to supermarket, they're expected to pay when they buy their groceries. in the case of medical care, there may still be an additional amount they owe, after copayment and insurance payment. if they can't or won't understand that, they are free to seek care elsewhere. if their copayment amount is not on the insurance card, you can electronically check it, along with other insurance elgibility, on line. hope that's helpful. politically incorrect and heretical. LOLLL Annie Skaggs <askaggsfayettefamilymed> wrote: I realize that I am committing a major sin of heresy here, but..... Has anyone besides me concluded that collecting copays prior to the visit is just about more trouble than it is worth? I know, I know...that's cashflow, and we are told that the bottom line will be better if we do that...but... It slows things down getting the patient into the room It means I have to keep running to the bank to get change, and I have to keep cash in the office overnight I don't take credit or debit cards, and keep thinking I will have to, at additional cost to me, because patients don't carry cash or checks The majority of my patients now STILL end up having to be billed for deductible, co-insurance and non-covered stuff, even if they paid the copay at the time of the visit, so it doesn't prevent having to send a bill Many insurance cards don't state the copay amount and most of those patients don't know what it is supposed to be High deductible plans say " there is a $30 copay after the $1500 deductible is met " , but we're not supposed to collect the $30 until then I have been having to waste time every month writing refund checks (usually 6-15 per month) because we collected too much somewhere along the line So, more and more I keep thinking that it would save me enough in time and efficiencyto be worth just skipping the copay collection and bill for the whole patient portion after insurance responds. Go ahead and shoot me, but then tell me what you really think.... Annie Don't let your dream ride pass you by. Make it a reality with Yahoo! Autos. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2007 Report Share Posted October 16, 2007 Annie, I have staff, so they do this piddly work for me. I collect at the time of visit, because when I haven't by the time the insurance has paid and we bill, it no longer seems so important to them. They seem to feel like, well I wasn't that sick, I really didn't need to be seen, or It's only $10, they can wait, I'll pay it later, and 2-3 bills later they still haven't paid. It's easier in my situation to take it now, than argue about it later. Also why don't your cards have it right on the card, most of ours do. We also have online access to check before the visit, it can even tell you sometimes if the deductable has been met, or not. If not, hey the whole bill is the patients. Most of my co-pays are $10-15, no $5, and only a few $25-30. My 2cents, but different model, different part of country, different payors. Cote' MD Four Corners Family Medicine Maple Valley , WA -------------- Original message -------------- Thanks for the responses. Just to clarify, I am not proposing not EVER collecting the copay, just delaying collecting it until we know what the entire patient responsibility is and billing it all at once. I know it is my responsibility to collect the copay amount, but I don't think my contracts say that I MUST collect them at the time of service, just that I must collect them. I agree with all the points about people taking some responsibility for the cost of their health care, and in general, the problem I bring up is not that patients are unwilling to pay thier copays. The problem is that it has become so cumbersome to do it at check in that I'm debating "bundling" copay collection into the billing on the backend. I think it was who said he likes to deposit the copays because he feels like he's making money, but most copays here are so low that I would never get a $200 deposit on copays alone. Most copays, if they are known up front, are still around $10 and many are $5 or even $4.50(hence the need to keep so much change..people keep wanting to pay a $4.50 copay with a $50 or $100 bill.) So, I'm thinking that if I just put up a sign that says "you will be billed for your portion of the cost of your visit" and eliminate the whole front end collection process it would save me at least an hour per day of time doing piddly stuff related to copays (trying to figure out what the amount should be, making change, writing a receipt, entering the amount on the deposit ticket, picking up change at the bank {which I can't do at the ATM when I make my deposit after hours}, refunding overcollection amounts, arguing with the habitual non-payers, etc, etc, etc) AND, the only cost to me (that I can think of) is a delay in getting those little bits of money until after insurance responds and the patient pays.... I guess maybe I should add up exactly how much money we are talking, but today was a really busy day and I still only got $75 in copay money. So I could bill the copays on the back end, wai t 6 weeks for that $75 and use the "extra" hour to see two more patients which would bring in about $160.....I think I'm talking myself into this plan, but I'm still open to arguement. Annie L. Skaggs, MD Lexington, KY www.fayettefamilymed.com -----Original Message-----From: [mailto: ] On Behalf Of lawrence lyonSent: Tuesday, October 16, 2007 1:08 PMTo: Subject: collecting copayments copayments are part of the patient responsibility wrt the insurance contract. patients know this, and it's your responsibility to know it, too. they also know that it's due up front, and may be required in order to be seen. this is an insurance company device designed to divide and conquer; it's under the guise of "making the patient take responsibility for their care"; it places a potential financial wedge between us and our patients, to prevent any alliance. in addition, higher copayments help to prevent patients from accessing care, which leads to lower insurance company payouts. an additional scenario goes, doctor, you knew that your patient had a critical medical condition, yet you failed to see the patient for further care, just because of a piddling $20 copay? to guard against this, document that you have informed the patient that they need to be seen, and refer them to a clinic where they can be seen irrespective of being able to afford and pay their copayment. it's still the patient's responsibility, and these copayments add up. if patients have difficulty with this, explain that when they go to supermarket, they're expected to pay when they buy their groceries. in the case of medical care, there may still be an additional amount they owe, after copayment and insurance payment. if they can't or won't understand that, they are free to seek care elsewhere. if their copayment amount is not on the insurance card, you can electronically check it, along with other insurance elgibility, on line. hope that's helpful. politically incorrect and heretical. LOLLLAnnie Skaggs <askaggsfayettefamilymed> wrote: I realize that I am committing a major sin of heresy here, but..... Has anyone besides me concluded that collecting copays prior to the visit is just about more trouble than it is worth? I know, I know...that's cashflow, and we are told that the bottom line will be better if we do that...but... It slows things down getting the patient into the room It means I have to keep running to the bank to get change, and I have to keep cash in the office overnight I don't take credit or debit cards, and keep thinking I will have to, at additional cost to me, because patients don't carry cash or checks The majority of my patients now STILL end up having to be billed for deductible, co-insurance and non-covered stuff, even if they paid the copay at the time of the visit, so it doesn't prevent having to send a bill Many insurance cards don't state the copay amount and most of those patients don't know what it is supposed to be High deductible plans say "there is a $30 copay after the $1500 deductible is met", but we're not supposed to collect the $30 until then I have been having to waste time every month writing refund checks (usually 6-15 per month) because we collected too much somewhere along the line So, more and more I keep thinking that it would save me enough in time and efficiencyto be worth just skipping the copay collection and bill for the whole patient portion after insurance responds. Go ahead and shoot me, but then tell me what you really think.... Annie Don't let your dream ride pass you by. Make it a reality with Yahoo! Autos. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2007 Report Share Posted October 16, 2007 I don't deal with insurance companies anymore, but from my past experience in a heavily capitated-care practice I think something should be clarified. Patients with capitated HMO insurance usually have a co-payment that per the insurance company is mandatory to be paid at the time of service and for which the physician is supposed to refuse to see the patient if it's not paid. With non-capitated insurance the patient typically has a share of the cost, either 100% before the deductible has been met or a share of the cost (20% or whatever) after the deductible has been met, and as far as I know that does not need to be paid by patients at the time of service. Those of you who have a system in place for figuring out in advance of receiving the EOB what a patient's responsibility will be can certainly have a policy of collecting this at the time of service and save on the cost of subsequently having to bill for it. Marty Thanks for the responses. Just to clarify, I am not proposing not EVER collecting the copay, just delaying collecting it until we know what the entire patient responsibility is and billing it all at once. I know it is my responsibility to collect the copay amount, but I don't think my contracts say that I MUST collect them at the time of service, just that I must collect them. I agree with all the points about people taking some responsibility for the cost of their health care, and in general, the problem I bring up is not that patients are unwilling to pay thier copays. The problem is that it has become so cumbersome to do it at check in that I'm debating " bundling " copay collection into the billing on the backend. I think it was who said he likes to deposit the copays because he feels like he's making money, but most copays here are so low that I would never get a $200 deposit on copays alone. Most copays, if they are known up front, are still around $10 and many are $5 or even $4.50(hence the need to keep so much change..people keep wanting to pay a $4.50 copay with a $50 or $100 bill.) So, I'm thinking that if I just put up a sign that says " you will be billed for your portion of the cost of your visit " and eliminate the whole front end collection process it would save me at least an hour per day of time doing piddly stuff related to copays (trying to figure out what the amount should be, making change, writing a receipt, entering the amount on the deposit ticket, picking up change at the bank {which I can't do at the ATM when I make my deposit after hours}, refunding overcollection amounts, arguing with the habitual non-payers, etc, etc, etc) AND, the only cost to me (that I can think of) is a delay in getting those little bits of money until after insurance responds and the patient pays.... I guess maybe I should add up exactly how much money we are talking, but today was a really busy day and I still only got $75 in copay money. So I could bill the copays on the back end, wait 6 weeks for that $75 and use the " extra " hour to see two more patients which would bring in about $160.....I think I'm talking myself into this plan, but I'm still open to arguement. Annie L. Skaggs, MD Lexington, KY www.fayettefamilymed.com -----Original Message-----From: [mailto: ] On Behalf Of lawrence lyonSent: Tuesday, October 16, 2007 1:08 PMTo: Subject: collecting copayments copayments are part of the patient responsibility wrt the insurance contract. patients know this, and it's your responsibility to know it, too. they also know that it's due up front, and may be required in order to be seen. this is an insurance company device designed to divide and conquer; it's under the guise of " making the patient take responsibility for their care " ; it places a potential financial wedge between us and our patients, to prevent any alliance. in addition, higher copayments help to prevent patients from accessing care, which leads to lower insurance company payouts. an additional scenario goes, doctor, you knew that your patient had a critical medical condition, yet you failed to see the patient for further care, just because of a piddling $20 copay? to guard against this, document that you have informed the patient that they need to be seen, and refer them to a clinic where they can be seen irrespective of being able to afford and pay their copayment. it's still the patient's responsibility, and these copayments add up. if patients have difficulty with this, explain that when they go to supermarket, they're expected to pay when they buy their groceries. in the case of medical care, there may still be an additional amount they owe, after copayment and insurance payment. if they can't or won't understand that, they are free to seek care elsewhere. if their copayment amount is not on the insurance card, you can electronically check it, along with other insurance elgibility, on line. hope that's helpful. politically incorrect and heretical. LOLLLAnnie Skaggs <askaggsfayettefamilymed> wrote: I realize that I am committing a major sin of heresy here, but..... Has anyone besides me concluded that collecting copays prior to the visit is just about more trouble than it is worth? I know, I know...that's cashflow, and we are told that the bottom line will be better if we do that...but... It slows things down getting the patient into the room It means I have to keep running to the bank to get change, and I have to keep cash in the office overnight I don't take credit or debit cards, and keep thinking I will have to, at additional cost to me, because patients don't carry cash or checks The majority of my patients now STILL end up having to be billed for deductible, co-insurance and non-covered stuff, even if they paid the copay at the time of the visit, so it doesn't prevent having to send a bill Many insurance cards don't state the copay amount and most of those patients don't know what it is supposed to be High deductible plans say " there is a $30 copay after the $1500 deductible is met " , but we're not supposed to collect the $30 until then I have been having to waste time every month writing refund checks (usually 6-15 per month) because we collected too much somewhere along the line So, more and more I keep thinking that it would save me enough in time and efficiencyto be worth just skipping the copay collection and bill for the whole patient portion after insurance responds. Go ahead and shoot me, but then tell me what you really think.... Annie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2007 Report Share Posted October 17, 2007 Ditto (wow, second time in a week I've said that... a new personal record!).Same as Gordon -- credit card machine on desk, takes 30 secs, sshmooze, etc.I also like the cash that I keep in an envelope on my desk (no concerns about it being stolen -- I trust my patients if I step into my back room to grab a vaccine or whatever... perhaps I'm wrong, but I like living that way consciously ... and I'm confident in the relationship I have with the patients). About twice I've needed to take a few $20's to the pizza parlor a few feet away and get $5s and $1s. Otherwise, no problems having change. Also, I mostly live off that copay cash (draws from the cash box) and, having cash in my life, rather than plastic cards, has changed, and I think improved, how I use money.So, overall, copays are fine with me for those reasons.Now, Larry's comments also resonate with me as I do believe the copay is insurance's way of passing some work off to us and dividing patient/doctor. If insurance wanted, they could simply increase the monthly premium to cover copays and then pay us the whole we deserve. But no, they make us do the money collecting... I should bill them for the time!! They say, " we pay $x for a 99213 " but in reality it's a big lie -- they pay $(x-copay)!Yeah, again, it's clear I'm frustrated with insurers.TimOn Tue, October 16, 2007 1:46 pm EDT, L. Gordon wrote: I have a credit card machine in the exam room. Takes about 30seconds max & meanwhile the pt and I are talking about other things,schmoozing, etc.I collect copay after the visit.GordonAt 01:07 PM 10/16/2007, you wrote:copayments are part of thepatient responsibility wrt the insurance contract. patients knowthis, and it's your responsibility to know it, too. they also knowthat it's due up front, and may be required in order to be seen.this is an insurance company device designed to divide and conquer; it'sunder the guise of " making the patient take responsibility for theircare " ; it places a potential financial wedge between us and ourpatients, to prevent any alliance. in addition, higher copaymentshelp to prevent patients from accessing care, which leads to lowerinsurance company payouts.an additional scenario goes, doctor, you knew that your patient had acritical medical condition, yet you failed to see the patient for furthercare, just because of a piddling $20 copay?to guard against this, document that you have informed the patient thatthey need to be seen, and refer them to a clinic where they can be seenirrespective of being able to afford and pay their copayment.it's still the patient's responsibility, and these copayments addup.if patients have difficulty with this, explain that when they go tosupermarket, they're expected to pay when they buy their groceries. in the case of medical care, there may still be an additional amount theyowe, after copayment and insurance payment. if they can't or won'tunderstand that, they are free to seek care elsewhere.if their copayment amount is not on the insurance card, you canelectronically check it, along with other insurance elgibility, online.hope that's helpful.politically incorrect and heretical.LOLLLAnnie Skaggs wrote:I realize that I am committing a majorsin of heresy here, but..... Has anyone besides me concluded thatcollecting copays prior to the visit is just about more trouble than itis worth? I know, I know...that's cashflow, and weare told that the bottom line will be better if we do that...but...It slows things down getting the patient into the room It means I have to keep running to thebank to get change, and I have to keep cash in the officeovernight I don't take credit or debit cards, andkeep thinking I will have to, at additional cost to me, because patientsdon't carry cash or checks The majority of my patients now STILLend up having to be billed for deductible, co-insurance and non-coveredstuff, even if they paid the copay at the time of the visit, so itdoesn't prevent having to send a bill Many insurance cards don't state thecopay amount and most of those patients don't know what it is supposed tobe High deductible plans say " there isa $30 copay after the $1500 deductible is met " , but we're notsupposed to collect the $30 until then I have been having to waste time everymonth writing refund checks (usually 6-15 per month) because we collectedtoo much somewhere along the lineSo, more and more I keep thinking that it would save me enough intime and efficiencyto be worth just skipping the copay collectionand bill for the whole patient portion after insuranceresponds. Go ahead and shoot me, but then tell mewhat you really think.... Annie Don't let your dream ride pass you by.Make it a reality with Yahoo! Autos. ---------------------------------------- Malia, MDMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments.---------------------------------------- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2007 Report Share Posted October 17, 2007 Ditto (wow, second time in a week I've said that... a new personal record!).Same as Gordon -- credit card machine on desk, takes 30 secs, sshmooze, etc.I also like the cash that I keep in an envelope on my desk (no concerns about it being stolen -- I trust my patients if I step into my back room to grab a vaccine or whatever... perhaps I'm wrong, but I like living that way consciously ... and I'm confident in the relationship I have with the patients). About twice I've needed to take a few $20's to the pizza parlor a few feet away and get $5s and $1s. Otherwise, no problems having change. Also, I mostly live off that copay cash (draws from the cash box) and, having cash in my life, rather than plastic cards, has changed, and I think improved, how I use money.So, overall, copays are fine with me for those reasons.Now, Larry's comments also resonate with me as I do believe the copay is insurance's way of passing some work off to us and dividing patient/doctor. If insurance wanted, they could simply increase the monthly premium to cover copays and then pay us the whole we deserve. But no, they make us do the money collecting... I should bill them for the time!! They say, " we pay $x for a 99213 " but in reality it's a big lie -- they pay $(x-copay)!Yeah, again, it's clear I'm frustrated with insurers.TimOn Tue, October 16, 2007 1:46 pm EDT, L. Gordon wrote: I have a credit card machine in the exam room. Takes about 30seconds max & meanwhile the pt and I are talking about other things,schmoozing, etc.I collect copay after the visit.GordonAt 01:07 PM 10/16/2007, you wrote:copayments are part of thepatient responsibility wrt the insurance contract. patients knowthis, and it's your responsibility to know it, too. they also knowthat it's due up front, and may be required in order to be seen.this is an insurance company device designed to divide and conquer; it'sunder the guise of " making the patient take responsibility for theircare " ; it places a potential financial wedge between us and ourpatients, to prevent any alliance. in addition, higher copaymentshelp to prevent patients from accessing care, which leads to lowerinsurance company payouts.an additional scenario goes, doctor, you knew that your patient had acritical medical condition, yet you failed to see the patient for furthercare, just because of a piddling $20 copay?to guard against this, document that you have informed the patient thatthey need to be seen, and refer them to a clinic where they can be seenirrespective of being able to afford and pay their copayment.it's still the patient's responsibility, and these copayments addup.if patients have difficulty with this, explain that when they go tosupermarket, they're expected to pay when they buy their groceries. in the case of medical care, there may still be an additional amount theyowe, after copayment and insurance payment. if they can't or won'tunderstand that, they are free to seek care elsewhere.if their copayment amount is not on the insurance card, you canelectronically check it, along with other insurance elgibility, online.hope that's helpful.politically incorrect and heretical.LOLLLAnnie Skaggs wrote:I realize that I am committing a majorsin of heresy here, but..... Has anyone besides me concluded thatcollecting copays prior to the visit is just about more trouble than itis worth? I know, I know...that's cashflow, and weare told that the bottom line will be better if we do that...but...It slows things down getting the patient into the room It means I have to keep running to thebank to get change, and I have to keep cash in the officeovernight I don't take credit or debit cards, andkeep thinking I will have to, at additional cost to me, because patientsdon't carry cash or checks The majority of my patients now STILLend up having to be billed for deductible, co-insurance and non-coveredstuff, even if they paid the copay at the time of the visit, so itdoesn't prevent having to send a bill Many insurance cards don't state thecopay amount and most of those patients don't know what it is supposed tobe High deductible plans say " there isa $30 copay after the $1500 deductible is met " , but we're notsupposed to collect the $30 until then I have been having to waste time everymonth writing refund checks (usually 6-15 per month) because we collectedtoo much somewhere along the lineSo, more and more I keep thinking that it would save me enough intime and efficiencyto be worth just skipping the copay collectionand bill for the whole patient portion after insuranceresponds. Go ahead and shoot me, but then tell mewhat you really think.... Annie Don't let your dream ride pass you by.Make it a reality with Yahoo! Autos. ---------------------------------------- Malia, MDMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments.---------------------------------------- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2007 Report Share Posted October 17, 2007 make 1 deposit weekly.... RE: collecting copayments Thanks for the responses. Just to clarify, I am not proposing not EVER collecting the copay, just delaying collecting it until we know what the entire patient responsibility is and billing it all at once. I know it is my responsibility to collect the copay amount, but I don't think my contracts say that I MUST collect them at the time of service, just that I must collect them. I agree with all the points about people taking some responsibility for the cost of their health care, and in general, the problem I bring up is not that patients are unwilling to pay thier copays. The problem is that it has become so cumbersome to do it at check in that I'm debating "bundling" copay collection into the billing on the backend. I think it was who said he likes to deposit the copays because he feels like he's making money, but most copays here are so low that I would never get a $200 deposit on copays alone. Most copays, if they are known up front, are still around $10 and many are $5 or even $4.50(hence the need to keep so much change..people keep wanting to pay a $4.50 copay with a $50 or $100 bill.) So, I'm thinking that if I just put up a sign that says "you will be billed for your portion of the cost of your visit" and eliminate the whole front end collection process it would save me at least an hour per day of time doing piddly stuff related to copays (trying to figure out what the amount should be, making change, writing a receipt, entering the amount on the deposit ticket, picking up change at the bank {which I can't do at the ATM when I make my deposit after hours}, refunding overcollection amounts, arguing with the habitual non-payers, etc, etc, etc) AND, the only cost to me (that I can think of) is a delay in getting those little bits of money until after insurance responds and the patient pays.... I guess maybe I should add up exactly how much money we are talking, but today was a really busy day and I still only got $75 in copay money. So I could bill the copays on the back end, wait 6 weeks for that $75 and use the "extra" hour to see two more patients which would bring in about $160.....I think I'm talking myself into this plan, but I'm still open to arguement. Annie L. Skaggs, MD Lexington, KY www.fayettefamilymed.com -----Original Message-----From: [mailto: ] On Behalf Of lawrence lyonSent: Tuesday, October 16, 2007 1:08 PMTo: Subject: collecting copayments copayments are part of the patient responsibility wrt the insurance contract. patients know this, and it's your responsibility to know it, too. they also know that it's due up front, and may be required in order to be seen. this is an insurance company device designed to divide and conquer; it's under the guise of "making the patient take responsibility for their care"; it places a potential financial wedge between us and our patients, to prevent any alliance. in addition, higher copayments help to prevent patients from accessing care, which leads to lower insurance company payouts. an additional scenario goes, doctor, you knew that your patient had a critical medical condition, yet you failed to see the patient for further care, just because of a piddling $20 copay? to guard against this, document that you have informed the patient that they need to be seen, and refer them to a clinic where they can be seen irrespective of being able to afford and pay their copayment. it's still the patient's responsibility, and these copayments add up. if patients have difficulty with this, explain that when they go to supermarket, they're expected to pay when they buy their groceries. in the case of medical care, there may still be an additional amount they owe, after copayment and insurance payment. if they can't or won't understand that, they are free to seek care elsewhere. if their copayment amount is not on the insurance card, you can electronically check it, along with other insurance elgibility, on line. hope that's helpful. politically incorrect and heretical. LOLLLAnnie Skaggs <askaggsfayettefamilymed> wrote: I realize that I am committing a major sin of heresy here, but..... Has anyone besides me concluded that collecting copays prior to the visit is just about more trouble than it is worth? I know, I know...that's cashflow, and we are told that the bottom line will be better if we do that...but... It slows things down getting the patient into the room It means I have to keep running to the bank to get change, and I have to keep cash in the office overnight I don't take credit or debit cards, and keep thinking I will have to, at additional cost to me, because patients don't carry cash or checks The majority of my patients now STILL end up having to be billed for deductible, co-insurance and non-covered stuff, even if they paid the copay at the time of the visit, so it doesn't prevent having to send a bill Many insurance cards don't state the copay amount and most of those patients don't know what it is supposed to be High deductible plans say "there is a $30 copay after the $1500 deductible is met", but we're not supposed to collect the $30 until then I have been having to waste time every month writing refund checks (usually 6-15 per month) because we collected too much somewhere along the line So, more and more I keep thinking that it would save me enough in time and efficiencyto be worth just skipping the copay collection and bill for the whole patient portion after insurance responds. Go ahead and shoot me, but then tell me what you really think.... Annie Don't let your dream ride pass you by. Make it a reality with Yahoo! Autos. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2007 Report Share Posted October 17, 2007 I rounded all my fees to the nearest $5...makes keeping change around easier. Marty Ditto (wow, second time in a week I've said that... a new personal record!).Same as Gordon -- credit card machine on desk, takes 30 secs, sshmooze, etc.I also like the cash that I keep in an envelope on my desk (no concerns about it being stolen -- I trust my patients if I step into my back room to grab a vaccine or whatever... perhaps I'm wrong, but I like living that way consciously ... and I'm confident in the relationship I have with the patients). About twice I've needed to take a few $20's to the pizza parlor a few feet away and get $5s and $1s. Otherwise, no problems having change. Also, I mostly live off that copay cash (draws from the cash box) and, having cash in my life, rather than plastic cards, has changed, and I think improved, how I use money. So, overall, copays are fine with me for those reasons.Now, Larry's comments also resonate with me as I do believe the copay is insurance's way of passing some work off to us and dividing patient/doctor. If insurance wanted, they could simply increase the monthly premium to cover copays and then pay us the whole we deserve. But no, they make us do the money collecting... I should bill them for the time!! They say, " we pay $x for a 99213 " but in reality it's a big lie -- they pay $(x-copay)! Yeah, again, it's clear I'm frustrated with insurers.Tim I have a credit card machine in the exam room. Takes about 30seconds max & meanwhile the pt and I are talking about other things,schmoozing, etc.I collect copay after the visit.Gordon At 01:07 PM 10/16/2007, you wrote: copayments are part of thepatient responsibility wrt the insurance contract. patients knowthis, and it's your responsibility to know it, too. they also knowthat it's due up front, and may be required in order to be seen. this is an insurance company device designed to divide and conquer; it'sunder the guise of " making the patient take responsibility for theircare " ; it places a potential financial wedge between us and our patients, to prevent any alliance. in addition, higher copaymentshelp to prevent patients from accessing care, which leads to lowerinsurance company payouts.an additional scenario goes, doctor, you knew that your patient had a critical medical condition, yet you failed to see the patient for furthercare, just because of a piddling $20 copay?to guard against this, document that you have informed the patient thatthey need to be seen, and refer them to a clinic where they can be seen irrespective of being able to afford and pay their copayment.it's still the patient's responsibility, and these copayments addup.if patients have difficulty with this, explain that when they go to supermarket, they're expected to pay when they buy their groceries. in the case of medical care, there may still be an additional amount theyowe, after copayment and insurance payment. if they can't or won't understand that, they are free to seek care elsewhere.if their copayment amount is not on the insurance card, you canelectronically check it, along with other insurance elgibility, online.hope that's helpful. politically incorrect and heretical.LOLLLAnnie Skaggs wrote: I realize that I am committing a majorsin of heresy here, but..... Has anyone besides me concluded thatcollecting copays prior to the visit is just about more trouble than itis worth? I know, I know...that's cashflow, and weare told that the bottom line will be better if we do that...but... It slows things down getting the patient into the room It means I have to keep running to thebank to get change, and I have to keep cash in the officeovernight I don't take credit or debit cards, andkeep thinking I will have to, at additional cost to me, because patientsdon't carry cash or checks The majority of my patients now STILLend up having to be billed for deductible, co-insurance and non-coveredstuff, even if they paid the copay at the time of the visit, so it doesn't prevent having to send a bill Many insurance cards don't state thecopay amount and most of those patients don't know what it is supposed tobe High deductible plans say " there isa $30 copay after the $1500 deductible is met " , but we're notsupposed to collect the $30 until then I have been having to waste time everymonth writing refund checks (usually 6-15 per month) because we collectedtoo much somewhere along the line So, more and more I keep thinking that it would save me enough intime and efficiencyto be worth just skipping the copay collectionand bill for the whole patient portion after insurance responds. Go ahead and shoot me, but then tell mewhat you really think.... Annie Don't let your dream ride pass you by. Make it a reality with Yahoo! Autos. ---------------------------------------- Malia, MDMalia Family Medicine & Skin Sense Laser 6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMalia www.SkinSenseLaser.com-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. ---------------------------------------- Quote Link to comment Share on other sites More sharing options...
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