The routine at the doctor’s office used to end by patients forking over the $20 or $35 co-pay at the receptionist’s desk. Weeks later, patients could expect a letter in the mail from their insurers, filled with inexplicable details regarding how much more the patient had to pay—10 percent of one set of charges, 50 percent of another, all encoded with jargon and acronyms that mean nothing to the layman.
Now, according to the WSJ, doctors’ offices are increasingly asking that patients pay all of their fees immediately after seeing their physician. This saves the doctor’s office the trouble of filing some paperwork, and the doctors like getting their money asap. It also obviously makes patients pay more money right away, which some folks may see as a burden. But you know what? I can see why most patients prefer it this way. At least you know what you owe after receiving the services, and at least there’s an actual human being in the doctor’s office who can tell you what you’re paying for and answer some questions. And they’ll do it pronto, not after you’ve phoned up and waited on hold while listening to repeated messages that there is “a heavy volume of calls” and “your call is important to us.”
Still, there has to be a simpler way to get services and handle payment without the mountain of confusing paperwork. (My family is currently covered by COBRA, which requires more paperwork than usual—one reason why I’ve said that “COBRA Bites.”)
There are also real concerns about doctors charging patients right away—namely that the doctor’s office can screw up and overcharge you, or the onus on justifying some treatment (even chemotherapy) to the insurance company can fall to the patients, after they’ve already paid. From the WSJ story:
For patients worried about a health concern and trying to absorb a doctor’s advice, attempting to understand a detailed medical bill before leaving the office can mean more stress. Adding to the hassle: Some practices don’t rely on a health plan’s detailed analysis, but rather charge based on cost estimates or projections, which aren’t always accurate. Later, patients may have to go over the bill again when they get their insurer’s formal statement.
Michael Gurion, an Atlanta attorney, says he didn’t object when an optometrist collected around $70 from him during a visit a few years ago for an exam and contact lenses. But months later, when he looked at his insurer’s explanation of benefits, he discovered he’d only owed about $25. He called the optometrist’s office and was told the difference was being kept by the practice as a credit toward future visits.
“I said, ‘Really? When were you going to tell me about this?’ ” says Mr. Gurion, 34, who says he wasn’t a regular patient and hadn’t planned to go to that optometrist again. In the end, Mr. Gurion says the office sent him a refund.
Practices that require deposits in advance of expensive procedures and tests, such as an MRI, also have to rely on projections. These doctors say they won’t withhold treatment to patients with serious conditions, and they set up payment plans if needed. But with elective procedures, says Jason Shelnutt, executive director of Georgia Urology in the Atlanta area, “we’re just not going to do them unless they pay” beforehand.
Mary Lou Hatch, 43, of Surprise, Arizona, delayed the start of chemotherapy for her breast cancer earlier this summer because the oncologist demanded $450 from her in advance. Ms. Hatch’s insurer had been refusing to handle her costs because of a dispute over her coverage. She finally paid the oncologist and started treatment about a month late. “I felt like I was over a barrel,” says Ms. Hatch, who hired the firm HealthCare Advocates Inc. to appeal her case with the insurer, which eventually started paying for her care.