Why I Won’t Collect Deductibles, Coinsurance at Time of Service

March 17, 2014

If it were possible to predict insurance payments, I wouldn’t be so overwhelmed by appeals and take backs.

I am currently overwhelmed with the reprocessing of claims that are well over a year old.

I’m not going to name the insurance companies that are currently causing me pain; the truth is all the payers do things like this from time to time, so it wouldn’t be professional to single a few out for something they have all been guilty of.

What angers me more this time, however, is that payers, including my current nemeses, are pushing the idea of collecting deductibles and coinsurance at the time of the appointment. Are they kidding? They are arguing my contracted fee 18 months after the appointment and they think they can help me estimate the patient’s responsibility at the time of the appointment? Give me a break.

I am also dealing with a 15-month old claim where the payer initially determined that the patient owed a huge deductible. I billed the patient, who didn’t pay, and I ended up paying a collection agency to help go after the money. The collection agency, nine months after the date of service, was successful. Now, another six months later, the payer has reprocessed the claim and states that the patient no longer owes as much. So, not only do I have to refund money to the patient, but I have to eat the 50 percent I gave to the collection agency to collect the patient payment. You can bet I won’t be using that collection service again.

On top of all this, new Massachusetts state laws now require insurance payers and us, the providers, to give patients out-of-pocket cost estimates prior to delivering services. As I write appeal after appeal, I am convinced that the lawmakers who came up with this idea have no grounding in the day-to-day realities of how insurance companies pay and sometimesreprocess over a year later, often for payments for seemingly routine, predictable care.

And now I must return to the mind-numbing writing of checks for 99 cents to patients who, according to the payer, overpaid a coinsurance over a year ago. After that I will return to reconciling $1.58 take backs in my practice management system. I do this while I simultaneously fight the payer since I think these claims were processed correctly 18 months ago, and these take backs are a mistake. Of course, if I succeed, that means billing patients for the 99 cents I am returning to them now. And the patients will be angry at me, not their insurer as they should be.

By the by, my personal “calendar year” high deductible plan will be switching to a “plan year” plan as of April 1 (meaning the deductible sets back to zero). The insurance payer only communicated this to me the first week in March. Assuming others in my community are facing a similar switch, I know I am going to have angry patients in my office when they learn their deductible that just reset on January 1 is now resetting again on April 1. Where is the consumer protection?

Right about now a single payer system is sounding pretty good to me.