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What Is Your Patient's True Financial Responsibility?


If your medical practice wants to get paid for services, do not accept financial responsibility for medical expenses that your patients incur.

When you open your doors to patients, are you setting yourself up for financial responsibility that is not yours to take? Oftentimes, practices confuse outstanding customer service with assuring patients that "we'll take care of everything; including billing insurance and assuming financial risk." Practices don't "actually" say these particular words, but how they verify insurance benefits and communicate them to patients can have serious ramifications for the financial health of their businesses.

This week, I will discuss areas where the patient is 100 percent responsible for medical expenses. Next week, I will review areas where the practice is responsible, and a small area of overlap, where both share responsibility.


• Coordinate benefits. Many patients have a primary and secondary insurance plan. Patients are solely responsible for managing these two plans. It is up to them to call each plan and let them know if they are a primary plan or a secondary plan. A physician's office has no jurisdiction to make this differentiation. Since the patient is the owner of the plan, only he can make that phone call.

•Pay copays, coinsurance, deductibles, or any other incurred cost. This may seem like it's a very logical statement, but all you need to do is look at your accounts receivable under the patient class to know they don't always feel the same way. It's a bit of a phenomenon that patients think they can walk in, obtain a service, and not pay for it. You would not be able to go to a restaurant or grocery store and walk out without paying, so why do practices have to suffer a nonpayment mindset?

• Read all Explanation of Benefits (EOB) as claims process. This is the insurance company's way of communicating with a patient. Most patients either throw them away, or just don't understand what they are reading. It is their responsibility to review the EOBs and make sure that the claim processed as it should have. If the EOB shows something different, it is their responsibility to call the insurance company to straighten out the problem.

• Cancel any appointment they cannot attend. Right, another easy one. But more often than not, people just blow off appointments leaving gaps in your schedule, where you could have scheduled a paying customer. Consider assessing a cancellation or no-show fee (I suggest $40 - hurts enough to "remember"), and if the patient does not have a legitimate reason for missing the appointment, send them a bill. Be sure this is clearly written in a cancellation policy that the patient signs at the beginning of treatment. If this is a new patient and you do not have their address, and they have not signed anything, it's a great opportunity for someone to call the patient. By calling them, you might be able to reschedule that patient.

• Provide accurate insurance information. You know the ones. Those patients who know their insurance plan has changed, but they don't have the new information yet, so they give you the old information. They really do think there is some magic computer in the cloud that holds everyone's information, and those physicians should just "know" the correct insurance identification numbers. As the owner of the plan, patients are required to know their insurance information, and if they want you to bill the plan, they must provide accurate information.

• Bring any referrals or authorizations provided to them. Whether a physician, a case manager, or the insurance company provides this, it is critical that patients provide this referral information to you at the time of their appointment, especially if you expect to be paid properly for the visit.

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