PCP Wants Full Charge Up Front [Primary Care Physician]

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dougger5
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PCP Wants Full Charge Up Front [Primary Care Physician]

Post by dougger5 »

We have our health insurance through one of the large national outfits, and our plan specifies a co-pay for office visits at the PCP of $20.00. Recently, the PCP announce that effective at a date shortly in the future, they will require $120.00 up front, which will be reimbursed as warranted, presumably after they are reimbursed by insurance.

We are seriously considering finding an alternative provider, but aside from how seriously I view the principle of, in effect, floating them a loan, I'm curious: Can they even do this? If they accept Company X insurance policies, isn't there a contractual obligation of some sort to abide by the co-pay requirements of Company X's policies?
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Mako
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Re: PCP Wants Full Charge Up Front

Post by Mako »

What about the principle that they are floating you a loan if they wait to take payment until (1) they are reimbursed by insurance, and/or (2) you pay the bill after insurance is settled.

Of course there are probably other PCPs that don't do this so you can vote with your wallet if you don't like it. I wouldn't like it either, but I don't begrudge them for it, they probably have had difficulty collecting payment.

Whether there is a contractual matter, no one here can know and that's between them and the insurance co. It's possible this is explained more in your plan documents but I just looked and mine didn't address this exact case. It's not a copay (to me) if it's just prepayment that is later reimbursed if not needed. I suppose you could point this out to the insurance co. and see what happens.
Last edited by Mako on Sun Aug 19, 2018 10:36 am, edited 1 time in total.
Turbo29
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Re: PCP Wants Full Charge Up Front

Post by Turbo29 »

dougger5 wrote: Sun Aug 19, 2018 10:25 am I view the principle of, in effect, floating them a loan,
The normal way, where the patient gets the service and then the provider waits for reimbursement, results in the provider floating the patient a loan.

Probably this is resulting because some insurance companies have not been paying in a timely manner or has been deciding not to cover certain procedures leaving the provider holding the bag. More evidence that the entire system is messed up.
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runner3081
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Re: PCP Wants Full Charge Up Front

Post by runner3081 »

This is becoming more common. There are too many deadbeats out there who don't pay their bills. An ever increasing bad debt line can really hurt a private practice.

I don't have a problem with it.

Keep in mind, no one complains when the dentist makes you pay up front (which most have done for ever!). Somehow, when a doctor does it, people don't like it.
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HueyLD
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Re: PCP Wants Full Charge Up Front

Post by HueyLD »

dougger5 wrote: Sun Aug 19, 2018 10:25 am We have our health insurance through one of the large national outfits, and our plan specifies a co-pay for office visits at the PCP of $20.00. Recently, the PCP announce that effective at a date shortly in the future, they will require $120.00 up front, which will be reimbursed as warranted, presumably after they are reimbursed by insurance.

We are seriously considering finding an alternative provider, but aside from how seriously I view the principle of, in effect, floating them a loan, I'm curious: Can they even do this? If they accept Company X insurance policies, isn't there a contractual obligation of some sort to abide by the co-pay requirements of Company X's policies?
I guess they can require you to make upfront full payments provided that they reimburse you for the difference.

However, it seems like a bookkeeping nightmare to me in addition to creating unhappy patients. I probably would change my PCP unless I really really like him (her).

Just imagine an ER facility asking for full payments of $100k upfront for insured patients......
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HueyLD
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Re: PCP Wants Full Charge Up Front

Post by HueyLD »

runner3081 wrote: Sun Aug 19, 2018 10:40 am This is becoming more common. There are too many deadbeats out there who don't pay their bills. An ever increasing bad debt line can really hurt a private practice.

I don't have a problem with it.

Keep in mind, no one complains when the dentist makes you pay up front (which most have done for ever!). Somehow, when a doctor does it, people don't like it.
OP has an insurance with a $20 copay and he should be required to pay $20 upfront. I don't see why he has to pay the full cost upfront.

And all the dentists I ever have only asked for copays and deductibles, not the entire "inflated" gross charges at the time of service. In fact, after a couple of insurance billings, they didn't even ask for copays or deductibles until after the insurance was processed.
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Re: PCP Wants Full Charge Up Front

Post by jhfenton »

I don't believe you will see the practice of demanding payment in full upfront become widespread. If they did so, it would reduce their ability to overcharge patients.

I pay for my annual CT scan upfront. I pay my optometrist up front. It's not surprising that those are two of my lowest cost and most financially-satisfying relationships with medical providers. When the charges are a surprise, it is always an unpleasant one.
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Re: PCP Wants Full Charge Up Front

Post by Nate79 »

runner3081 wrote: Sun Aug 19, 2018 10:40 am This is becoming more common. There are too many deadbeats out there who don't pay their bills. An ever increasing bad debt line can really hurt a private practice.

I don't have a problem with it.

Keep in mind, no one complains when the dentist makes you pay up front (which most have done for ever!). Somehow, when a doctor does it, people don't like it.
+1
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Re: PCP Wants Full Charge Up Front

Post by Rupert »

It wouldn't bother me but for the fact that doctors' offices, in general, are terrible at reimbursing patients for overpayments. I recently saw a doctor (a specialist) I hadn't seen in about 3 years, and they told me I owed no co-pay because I had a $30 credit on my account. When exactly were they planning to tell me they owed me $30? What if I had never made another appointment to see that doctor?
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Re: PCP Wants Full Charge Up Front

Post by cockersx3 »

Have not heard of this at doctors, but have occasionally run into situations like this at lab service providers. At one national lab chain, they frequently ask to run my credit card and put a "hold" for list price of service. They can charge it immediately after insurance amount is established.

When this happens, I just politely decline. And they take my blood anyway. Just because they make a request does not mean you need to comply.

If I was the OP, I would just find another doctor. If the physician wants to create a new status quo that is more financially beneficial to him, good for him. But the OP has options too. Maybe if enough patients vote with their feet, the physician will change his kind.

And yes, I agree with the previous poster that the system IS definitely messed up.
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Re: PCP Wants Full Charge Up Front

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Re: PCP Wants Full Charge Up Front

Post by ThriftyPhD »

Mako wrote: Sun Aug 19, 2018 10:34 am Of course there are probably other PCPs that don't do this so you can vote with your wallet if you don't like it. I wouldn't like it either, but I don't begrudge them for it, they probably have had difficulty collecting payment.
One option if they're having trouble collecting payment from the insurer is for the practice to leave that insurer's network.

Every time I've prepaid for medical procedures and was owed a refund, getting that money back was a massive amount of work. For some reason once they have your money, most organizations lose motivation for settling the account.
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Re: PCP Wants Full Charge Up Front

Post by mountaingoatcos »

this often has to do with high-deductible health plans. If you have a $20 copay but have not met your deductible, you are responsible for the full amount after any insurance discounts. Some doctors are not collecting any money besides the copay from patients on high-deductible plan because they decide not to pay the bill. I suspect this is why this doctor is doing it, and it is becoming more common.
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Re: PCP Wants Full Charge Up Front

Post by nyclon »

dougger5 wrote: Sun Aug 19, 2018 10:25 am We have our health insurance through one of the large national outfits, and our plan specifies a co-pay for office visits at the PCP of $20.00. Recently, the PCP announce that effective at a date shortly in the future, they will require $120.00 up front, which will be reimbursed as warranted, presumably after they are reimbursed by insurance.

We are seriously considering finding an alternative provider, but aside from how seriously I view the principle of, in effect, floating them a loan, I'm curious: Can they even do this? If they accept Company X insurance policies, isn't there a contractual obligation of some sort to abide by the co-pay requirements of Company X's policies?
I've come across similar nonsense recently. If you've checked with the carrier that you owe just $20 upfront, get a reference number proving this (the carrier will provide this). The doctor has a contract with the carrier - if they are insecure about being reimbursed by the carrier, they should do business elsewhere and stop getting the network's customer inflow. This is fraud. Find a new doctor.
drk
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Re: PCP Wants Full Charge Up Front

Post by drk »

Hearing that would make me concerned that the practice is not financially healthy. Shoring up their finances via patients may make sense (payment at time of service seems to work for chiropractors, psychiatrists, etc.), but it would make me start looking for a new physician.
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Re: PCP Wants Full Charge Up Front

Post by nisiprius »

I don't think it's appropriate for a primary care doctor. My doctors have never done this and I haven't yet heard any stories from other people. Furthermore, if it happened to me I would definitely call my insurance company and ask "can they do this?" because whatever the law is, it mightbe against the contract they have made with the insurer. I think insurers might be unhappy with this practice, because it would seem to make it easier for the doctor to collect a double payment (one from the patient and one from the insurer).

In my area it is, however, common for veterinarians to demand payment at time of service--but pets don't normally have health insurance.

I would ask around and see if this is common in your area.
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Re: PCP Wants Full Charge Up Front

Post by dm200 »

I wonder if such a requirement (however 'justified') might violate the terms of insurance - both terms with the patient and with the physician.
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Re: PCP Wants Full Charge Up Front

Post by dm200 »

nisiprius wrote: Sun Aug 19, 2018 12:13 pm I don't think it's appropriate for a primary care doctor. My doctors have never done this and I haven't yet heard any stories from other people. Furthermore, if it happened to me I would definitely call my insurance company and ask "can they do this?" because whatever the law is, it might or might not be against the contract they have with the insurer. I would be prepared for the insurer to say "Yeah, they can do it" but I would, nevertheless, take the time to ask.
In my area it is, however, common for veterinarians to demand payment at time of service--but pets don't normally have health insurance.
I would ask around and see if this is common in your area.
Right!

I am reminded of the Rodney Dangerfield "one liner" - I told my Psychiatrist I had suicidal thoughts. He then said he would now like me to pay in advance.
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Re: PCP Wants Full Charge Up Front

Post by Doom&Gloom »

letsgobobby wrote: Sun Aug 19, 2018 11:17 am
dougger5 wrote: Sun Aug 19, 2018 10:25 am We have our health insurance through one of the large national outfits, and our plan specifies a co-pay for office visits at the PCP of $20.00. Recently, the PCP announce that effective at a date shortly in the future, they will require $120.00 up front, which will be reimbursed as warranted, presumably after they are reimbursed by insurance.

We are seriously considering finding an alternative provider, but aside from how seriously I view the principle of, in effect, floating them a loan, I'm curious: Can they even do this? If they accept Company X insurance policies, isn't there a contractual obligation of some sort to abide by the co-pay requirements of Company X's policies?
I'm a physician and think this is outrageous. It would be fair to require your copay upfront, but no more than that. Really this is a contractual dispute between your doctor and the payer, and if he is not being paid in a timely manner by the insurance company he has options (canceling his contract with insurance company, negotiating with them) that don't involve unilaterally punishing every patient and running some kind of payday loan operation. In essence your doctor is triangulating and it's neither professional nor in my opinion ethical to double bill for services (you, then the insurance company), and only then reimburse one or the other.

I would ask him to reconsider. If he won't I would write him an earnest letter detailing my ethical qualms with his practice. If no movement I would find another doctor and consider a complaint to his insurance company, the state insurance commission, the state licensing board, and his professional organization, if any.
+1

This is the path I would take toward a resolution.
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Re: PCP Wants Full Charge Up Front

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JPM
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Re: PCP Wants Full Charge Up Front

Post by JPM »

I am also a PCP. Was in private practice for 30 years and employed by a large group for the past 9 years. Most PCPs in metropolitan areas are in employed positions now. In the case of employed physicians, the employer sets the policy, usually collection of copay upfront.

The nature of insurance contracting is that the doctor, clinic or the doctor's employer contract with an insurer to pay a certain percentage of the fixed medicare rate for a particular service. Unless your employer has a lot of market power, the insurer lets the contract on a "a take it or leave it basis" In my locale, primary care contracts are usually for 110-125% of the medicare rate. In private practice, our best contract was 145% of the medicare rate. So for the usual kind of care, say a visit for bronchitis resulting in a prescription, the medicare rate is approximately $100. Privately insured patients paid anywhere from $110-$145 for the same service and copays ranged from $0-$25. Unlike most other businesses the same product or service has differing costs to different people depending on the nature of their insurance plan. We dealt with over 600 insurance plans as a small group and it was not practical to have a different charge chart for each one, so we charged everyone 145% of medicare and for all but one plan wrote off the difference between our charge and the contractual allowance as a contractual discount.

Many people now have high deductible plans, i.e. $5000-$10,000 which make them in effect cash payers for primary care unless and until some hospital stay or surgery causes them to exceed the large deductible. Low income people with these high deductible insurance plans often struggle to pay medical bills and they get paid after the mortgage/rent, utilities, etc. If practicing independently in a low income area with important local employers providing the high deductible plans, maybe cash upfront is the way they feel they have to handle it.

In my time in private practice, patients were put on a "cash only" basis only if they had histories of nonpayment or unreasonably slow payment when we felt we knew they had the money. When we knew it was a struggle for some people to pay, we put them on monthly payment plans and that generally worked out. We wrote out refund checks monthly to redress overpayments.
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Re: PCP Wants Full Charge Up Front

Post by LadyGeek »

This thread is now in the Personal Finance (Not Investing) forum (insurance).

JPM, Welcome!
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dougger5
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Re: PCP Wants Full Charge Up Front

Post by dougger5 »

Turbo29 wrote: Sun Aug 19, 2018 10:36 am The normal way, where the patient gets the service and then the provider waits for reimbursement, results in the provider floating the patient a loan.

Probably this is resulting because some insurance companies have not been paying in a timely manner or has been deciding not to cover certain procedures leaving the provider holding the bag. More evidence that the entire system is messed up.
OP here -
Fair points. But I would consider the "normal" way as being the proverbial cost of doing business.

Totally agree with the conclusion of the second point.
letsgobobby wrote: Sun Aug 19, 2018 11:17 am I'm a physician and think this is outrageous. It would be fair to require your copay upfront, but no more than that. Really this is a contractual dispute between your doctor and the payer, and if he is not being paid in a timely manner by the insurance company he has options (canceling his contract with insurance company, negotiating with them) that don't involve unilaterally punishing every patient and running some kind of payday loan operation. In essence your doctor is triangulating and it's neither professional nor in my opinion ethical to double bill for services (you, then the insurance company), and only then reimburse one or the other.

I would ask him to reconsider. If he won't I would write him an earnest letter detailing my ethical qualms with his practice. If no movement I would find another doctor and consider a complaint to his insurance company, the state insurance commission, the state licensing board, and his professional organization, if any.
Indeed, I didn't mind at all when they began to take the copay up front - makes no difference to me if it's before or after service.

As someone else mentioned, it has made me wonder about the soundness of the practice. And along with wondering if what they're doing is kosher from a contractual standpoint, relative to the insurer(s), I also wonder if any thought was given to the effect of this new policy. Surely they must have anticipated some fallout.

We've had other issues with the practice, mainly on the administrative side - misplacement of records needed for a term life policy application, most recently. So I think we're going to explore other options.

As to the high deductible plan issue, I have an acquaintance who works in another medical field. They said in those cases, they make sure that at the time of the appointment, that they inform the patient of what they'll be on the hook for. That mitigates the accounts receivable situation somewhat, although there are still a certain amount of clients who conveniently forget to bring their checkbook along, and such.

But the point is, those cases are handled individually at that practice.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by dm200 »

A few years ago, it was confusing (maybe complex) what the copay should be for each of several physicians I saw. The receptionist would often ask me, "Do you know your copay?" I would say I did not know - and to bill me.

Worked fine.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by curious george »

A good, compassionate and smart PCP is worth a lot. If this is the only issue or complaint, I would live with it.
It does seem odd that for every other service - mechanic, barber, restaurant, etc - payment is expected at the time of service and it doesnt bother us and is viewed as fair. However, when a doctor does it, it upsets us.
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Re: PCP Wants Full Charge Up Front

Post by drawpoker »

mountaingoatcos wrote: Sun Aug 19, 2018 11:43 am this often has to do with high-deductible health plans. If you have a $20 copay but have not met your deductible, you are responsible for the full amount after any insurance discounts. Some doctors are not collecting any money besides the copay from patients on high-deductible plan because they decide not to pay the bill. I suspect this is why this doctor is doing it, and it is becoming more common.
Exactly. You have hit on this correctly, your suspicion is right.

And you know why it is becoming more common? Because HD health plans are becoming more and more common.
Very likely the OP's doctor is tired of sending out many statements every month with balance due amounts. Then, either waiting months and months for payment, or having to wait until the next time the patient comes into the office. Then will sheepishly pay up.

So some will say if you don't like it, find another doctor. Or, if you don't like it, find another health insurance policy.
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Re: PCP Wants Full Charge Up Front

Post by Turbo29 »

drawpoker wrote: Sun Aug 19, 2018 4:52 pm
mountaingoatcos wrote: Sun Aug 19, 2018 11:43 am this often has to do with high-deductible health plans. If you have a $20 copay but have not met your deductible, you are responsible for the full amount after any insurance discounts. Some doctors are not collecting any money besides the copay from patients on high-deductible plan because they decide not to pay the bill. I suspect this is why this doctor is doing it, and it is becoming more common.
Exactly. You have hit on this correctly, your suspicion is right.

And you know why it is becoming more common? Because HD health plans are becoming more and more common.
Very likely the OP's doctor is tired of sending out many statements every month with balance due amounts. Then, either waiting months and months for payment, or having to wait until the next time the patient comes into the office. Then will sheepishly pay up.

So some will say if you don't like it, find another doctor. Or, if you don't like it, find another health insurance policy.
This is true, I have a HDHP; my PCP collects nothing and bills me for the full amount. My dermatologist, on the other hand, has an online connection to the insurance company and can tell at the end of the visit how much I owe based on what was done at the visit and their contracted rate. I understand why they are doing it and have no problem paying them at the end of the visit.
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Re: PCP Wants Full Charge Up Front

Post by EnjoyIt »

JPM wrote: Sun Aug 19, 2018 3:08 pm
Many people now have high deductible plans, i.e. $5000-$10,000 which make them in effect cash payers for primary care unless and until some hospital stay or surgery causes them to exceed the large deductible. Low income people with these high deductible insurance plans often struggle to pay medical bills and they get paid after the mortgage/rent, utilities, etc. If practicing independently in a low income area with important local employers providing the high deductible plans, maybe cash upfront is the way they feel they have to handle it.
In this day of healthcare most people have high deductibles and there is a growing percentage of people with those plans who simply don't pay the deductible. This is the solution and I think it will become more and more common over the next 5 years.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by Northern Flicker »

The point of a copay (as opposed to co-insurance) is that the patient responsibility is precisely known and collected at time of service. Because this removes the uncertainty of collecting the patient co-insurance obligation after billing the insurance company, it should in theory result in lower overall costs as the costs don’t have to include a contribution for unpaid bills of other patients.

As such, it is ridiculous to ask for full payment upfront and I’d even think it ought to be a violation of the contract with the insurance company to ask for more than the copay.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by OnTrack2020 »

Every medical office varies. We ran into this with a dentist (specialist) where they wanted payment up front (over $900) and then we would be reimbursed from the insurance company for the amount not owed. When I asked about it, they mentioned that was how they had set it up with the insurance company. It worked well. We received reimbursement a week or so later from the insurance company.

Very rarely have I seen it work as well as this did. The vast majority of physician offices we've dealt with keep the money on account as a credit. I imagine this PCP is seeing more people on a HDHP where the average office visit is going to be over $100. Therefore, it makes sense. However, if he has a contract with your insurance company, I'm not sure it's legit to collect anything other than the co-pay at time of service. I would double check with your insurance company, but I believe he's bound by the contract he signed with them.

What drives me crazy is when you have a doctor's appointment, pay the co-pay, and then have a follow-up appointment in two weeks for the same issue and have to shell out another co-pay. :shock:

I should also add that the beginning of the year we switched from a plan with a co-pay/FSA to a HDHP/HSA. One of our doctors' offices still collects the co-pay; the other we just have them bill us due to the HDHP. We pay the dentist after receiving the EOB because his charges are more of an estimate. And the urgent care place just bills us. Note that we've been patients at these offices for close to two decades, try to always place a priority on paying our medical bills, so think there's a little more leeway.
Last edited by OnTrack2020 on Sun Aug 19, 2018 5:39 pm, edited 2 times in total.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by ClevrChico »

I had a dentist do this for the amount they estimated I would be responsible for. And it was always more money than I owed after the insurance settled, resulting in a credit balance. I wouldn't get reimbursed for the credit balance until Q1 of the following year. He definitely lost patients over it.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by Broken Man 1999 »

Here we have seen more than one example of someone having a HDHP and receiving the high bill due to their deductible.

Those lower premiums are great, but when the high bill hits, some are looking for a way to off-load it somewhere else.

Maybe there should be a requirement for anyone with a HDHP to post a bond for their deductible. Safeguards the service provider.

I don't think it is fair for a doctor to be ripped off, but that is just me.

If my PCP instituted a pre-pay plan, I would be fine with it. His is a single doctor practice, and he has expenses to recover. I wouldn't leave him even if he wasn't in my insurance plan; a few hundred dollars to see him a couple of times a year would be perfectly acceptable.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by simas »

Another patient here who is completely in support of what your PCP is doing

I also do not understand the whole 'Up Front' language - up front is when they ask for you to pay now for services say a year from now. When you pay the day you receive services, what is "up front" about it? anything else is "may be later, if and whenever I feel like it and get to it" approach

I want my PCP to survive (small practice) and happy to pay trivial amount I would be paying anyway. I 'win' nothing if he goes out of business.

Second thing I do see around me (Chicago) that is currently developing is the requirement of "retainer" , if you want to be a patient, you pay for it annually as well as limits on amount of patients (not taking new patients, etc) . don't like it - plenty of competitors around and you are welcome to find something else and cheap each time going to people who have no idea who you are and have no relationship with you.

Same approach works with say car care - if you want the cheapest service possible and finding coupons to save few bucks, sure. however, some of us want the mechanic who knows us , knows our cars, and we know we can trust vs trying to get the cheapest provider possible. what goes around comes around. and since my health is much more important to me than my car (I can always buy new car , you can not buy new body), I want that connection and trust even more so with PCP.


in your case you did not like the practice anyway so switch may be prudent.. you are voting/judging with your wallet each time you make a purchasing decision..
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by HIinvestor »

Our insurance policy and what all participating in network providers sign says NO payments by patients until after insurance pays. That said, some offices have us pay our $15 copay unless we are getting near our OOP maximum or for H who has Medicare as his primary and generally only has copays for dental, vision and some Rx.

I guess I’d be OK with any office who wanted me to pay for the entire office visit up front, but it would make more work for them as they’d have to refund everything but $15, or if we hit OOP max, 100% refund.

Thankfully, my providers never ask for more than $15 and know we pay our balance as soon as we receive the invoice after insurer pays (of course copays for dental and vision vary).
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Re: PCP Wants Full Charge Up Front

Post by Dottie57 »

Turbo29 wrote: Sun Aug 19, 2018 5:02 pm
drawpoker wrote: Sun Aug 19, 2018 4:52 pm
mountaingoatcos wrote: Sun Aug 19, 2018 11:43 am this often has to do with high-deductible health plans. If you have a $20 copay but have not met your deductible, you are responsible for the full amount after any insurance discounts. Some doctors are not collecting any money besides the copay from patients on high-deductible plan because they decide not to pay the bill. I suspect this is why this doctor is doing it, and it is becoming more common.
Exactly. You have hit on this correctly, your suspicion is right.

And you know why it is becoming more common? Because HD health plans are becoming more and more common.
Very likely the OP's doctor is tired of sending out many statements every month with balance due amounts. Then, either waiting months and months for payment, or having to wait until the next time the patient comes into the office. Then will sheepishly pay up.

So some will say if you don't like it, find another doctor. Or, if you don't like it, find another health insurance policy.
This is true, I have a HDHP; my PCP collects nothing and bills me for the full amount. My dermatologist, on the other hand, has an online connection to the insurance company and can tell at the end of the visit how much I owe based on what was done at the visit and their contracted rate. I understand why they are doing it and have no problem paying them at the end of the visit.
Aslng as “adjudication” of the claim can be done that quickly I am fine paying.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by TravelGeek »

dougger5 wrote: Sun Aug 19, 2018 10:25 am Recently, the PCP announce that effective at a date shortly in the future, they will require $120.00 up front, which will be reimbursed as warranted, presumably after they are reimbursed by insurance.

We are seriously considering finding an alternative provider
Did you ask them why they are doing this?
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by whodidntante »

This might be due to higher default rates. HDHPs are more common now, and I suspect some people just don't buy insurance now that the individual mandate has been done away with (aka not enforced).

But I suspect the OP would pay what is owed regardless. If you like the doc, stay. If you didn't, or kinda didn't, go. As long as I can pay by credit card and get a cash/check refund I wouldn't mind at all.
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Re: PCP Wants Full Charge Up Front

Post by Northern Flicker »

mountaingoatcos wrote: Sun Aug 19, 2018 11:43 am this often has to do with high-deductible health plans. If you have a $20 copay but have not met your deductible, you are responsible for the full amount after any insurance discounts. Some doctors are not collecting any money besides the copay from patients on high-deductible plan because they decide not to pay the bill. I suspect this is why this doctor is doing it, and it is becoming more common.
When a deductible must first be met, the patient responsibility is normally described as co-insurance, not as a co-pay. A co-pay applies to a visit when the insurance arrangement is that the patient pays the copay at time of service and the provider collects the rest from the insurer.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by munemaker »

When you are in a situation you don't like, you have to consider available alternatives.

Does this billing practice bother you enough to change to a different PCP/practice that does business more conventionally? Personally, I would give that strong consideration if available.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by eye.surgeon »

dougger5 wrote: Sun Aug 19, 2018 10:25 am We have our health insurance through one of the large national outfits, and our plan specifies a co-pay for office visits at the PCP of $20.00. Recently, the PCP announce that effective at a date shortly in the future, they will require $120.00 up front, which will be reimbursed as warranted, presumably after they are reimbursed by insurance.

We are seriously considering finding an alternative provider, but aside from how seriously I view the principle of, in effect, floating them a loan, I'm curious: Can they even do this? If they accept Company X insurance policies, isn't there a contractual obligation of some sort to abide by the co-pay requirements of Company X's policies?
The fact that this question is even being asked indicates how little people understand about health insurance.

Your doctor files an insurance claim for your visit as a courtesy and convenience to you, so you don't have to do it. By no means are they obligated to do so. If that bothers you, you can certainly switch doctors, but if finding a good primary care doctor that accepts new patients is as difficult as it is in much of the US, good luck.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by Big Dog »

The fact that this question is even being asked indicates how little people understand about health insurance.

Your doctor files an insurance claim for your visit as a courtesy and convenience to you, so you don't have to do it.
With all due respect, it depends on the contract that the PCP has with the 'national outfit' and the contract that the employer has with the national insurer.

Certain PCP contracts basically say, 'charge the patient the $20 and we will pay you the balance of the contracted amount in xx days.' Any float is by contract design. In such cases, the pt should not feel bad. If the PCP didn't like the deal, s/he didn't have to sign up.

So, the advice to the OP is to call customer service of the national outfit ('800' number on your ID card) and ask if you are supposed to be paying in full and then obtaining a refund, or just the $20 copay as stated on the card. The second call is to Human Resources if this is an employer plan.
Recently, the PCP announce that effective at a date shortly in the future, they will require $120.00 up front,
What this likely indicates is the said PCP is dropping out of the Network. OP should ask that question. And if the answer is, 'yes, dropping out of network as of xx date', OP should start shopping for new PCP to keep in-network benefits.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by dougger5 »

OP here again.

Just to clarify: My plan is a PPO (Preferred Provider Organization) plan, not a HDHP (High Deductible Health Plan), although I realize that the proliferation of the latter type may play into this state of affairs.

I'll also point out some false equivalencies offered in the foregoing. For example, my car insurance does not cover routine care, let alone have any copay component. Therefore I understand that in the case of the mechanic's service I must treat the payment arrangement differently.

Someone suggested that I ask why they are doing this. The email from the office's billing company which announced the policy included a Word document that explained it:
Word Doc Attachment From Billing Company wrote: For Our Valued Patients:

In 25 years of providing care in our community, we have seen many changes in medical care and insurance reimbursement for that care. With medical insurance transformations over the last few years we have seen drastic deviations in how the office is reimbursed for the care we provide. This has increased cost and slowed reimbursement.
Starting August 20, 2018, it will be necessary to pay for an office visit at the time of service. This will involve either cash or credit card payments in the amount of $120.00. The visit will be submitted to the appropriate insurance company in a timely manner. If a refund is required, it will be processed and returned the patient as soon as possible.
Thank you in advance for your cooperation.
Not real specific, but leads one to suspect HDHP's as contributing to the problem. I suppose if I did ask, it would be for clarification on this.
eye.surgeon wrote: Sun Aug 19, 2018 7:37 pm The fact that this question is even being asked indicates how little people understand about health insurance.

Your doctor files an insurance claim for your visit as a courtesy and convenience to you, so you don't have to do it. By no means are they obligated to do so. If that bothers you, you can certainly switch doctors, but if finding a good primary care doctor that accepts new patients is as difficult as it is in much of the US, good luck.
I enrolled in an insurance plan which told me that if I payed them X a month, that I was then entitled to a benefit. The terms of this benefit includes a copay of $20 to in-network PCP's for office visits.

So inasmuch as I expected this to be an actual benefit, in return for my non-trivial monthly premium payment, then I guess I am naive.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by mattsm »

Speaking of high deductible plans... you can't do the opposite which is get a price up front which drives me nuts. Go to doctor, find out weeks later what you owe for some procedure. It's f-ing nuts!

If you want me to pre-pay $120, then that should be the max possible you owe and I'd be fine with that.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by mattsm »

eye.surgeon wrote: Sun Aug 19, 2018 7:37 pm
dougger5 wrote: Sun Aug 19, 2018 10:25 am We have our health insurance through one of the large national outfits, and our plan specifies a co-pay for office visits at the PCP of $20.00. Recently, the PCP announce that effective at a date shortly in the future, they will require $120.00 up front, which will be reimbursed as warranted, presumably after they are reimbursed by insurance.

We are seriously considering finding an alternative provider, but aside from how seriously I view the principle of, in effect, floating them a loan, I'm curious: Can they even do this? If they accept Company X insurance policies, isn't there a contractual obligation of some sort to abide by the co-pay requirements of Company X's policies?
The fact that this question is even being asked indicates how little people understand about health insurance.

Your doctor files an insurance claim for your visit as a courtesy and convenience to you, so you don't have to do it. By no means are they obligated to do so. If that bothers you, you can certainly switch doctors, but if finding a good primary care doctor that accepts new patients is as difficult as it is in much of the US, good luck.
Except most doctors office CAN'T (or won't) provide pricing up front. I'm fine filing claims and paying things if they provide the pricing. Pricing comes back weeks or days later and you have no idea what you owe if you're on a higher deductible plan. It's insane, I can't shop around or even make informed decisions about my care and the costs.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by HornedToad »

eye.surgeon wrote: Sun Aug 19, 2018 7:37 pm Your doctor files an insurance claim for your visit as a courtesy and convenience to you, so you don't have to do it. By no means are they obligated to do so.
I think you are using the term courtesy and convenience when you should be saying in order to be market competitive. Paying the copay at time of service, no problem Paying the full amount and then they also get reimbursed by insurance company and *eventually* reimburses the patient. That's a problem.

If instead the patient paid the entire amount upfront and the insurance company would reimburse the patient directly then that would be a different situation. But that is not the normal scenario in our health care system for in-network providers.
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Re: PCP Wants Full Charge Up Front

Post by BolderBoy »

mountaingoatcos wrote: Sun Aug 19, 2018 11:43 am this often has to do with high-deductible health plans. If you have a $20 copay but have not met your deductible, you are responsible for the full amount after any insurance discounts. Some doctors are not collecting any money besides the copay from patients on high-deductible plan because they decide not to pay the bill. I suspect this is why this doctor is doing it, and it is becoming more common.
I agree with this assessment. Most insurances have a copay & deductible. If the provider bills right away s/he may find that the deductible due is assigned by the insurance company to his/her bill and may never get paid beyond the copay. The EOB sent to the patient will clearly show how much is owed to whom. It becomes a game of who bills first (among many providers involved in a case), to try to get the deductible assigned to someone else. Frequently that is what is going on when a provider waits months to submit the billing to the insurance.
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Re: PCP Wants Full Charge Up Front

Post by AlphaLess »

HueyLD wrote: Sun Aug 19, 2018 10:44 am Just imagine an ER facility asking for full payments of $100k upfront for insured patients......
I don't see a typical ER visit costing $100K.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by InMyDreams »

Assuming that this is a participating provider, ask your insurance company what its contract with the provider specifies.

In years gone by, the insurance company told me that only a co-payment is due at time of service, and that I shouldn't pay anything more until the EOB arrived.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by HueyLD »

To the OP,

I don't know where you live, but be very careful about switching your PCP.

As others have indicated, a good PCP is worth a ton of gold. In addition, there appears to be a shortage of PCPs in many parts of the country and many PCPs do not even accept new patients (including mine).

Our health care system is royally messed up indeed.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by J295 »

I’m much more interested in the quality of care from my primary care physician/internist than I am about whether or not there is extra $100 cost, or I don’t have $100 for a few weeks or a few months pending a determination of my insurance coverage…
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