Patients Are Using This Little Know “Patient Right” To Reduce Your Cost of Seeing the Doctor

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Does Your Office Know About It?

For most people, a deductible before their health benefits kick in is now the norm. And as those deductibles go up, and up, each year, fewer and fewer people get any benefit of having insurance, to begin with. Yes, it’s nice to have it, there as a security blanket for a major illness but having insurance may actually cause the patient to spend more than necessary, before exhausting the deductible. And for most people, meeting their deductible is just not happening.

According to an analysis by eHealthInsurance.com of one large insurer’s 2012 claims, just under 11 percent of people with a $2,500 deductible met the deductible for that year. For those with a $5,000 deductible plan, the figure dropped to just under 4 percent. Only 3 percent of people with a $7,500 deductible had that much in claims, and at the $10,000 deductible level, the figure was just over 2 percent.

Most of your patients are likely in that 89% (at the $2500 deductible level).

But what makes the situation worse for patients who are relatively healthy, they still may need periodic medical care, and during that deductible period, more and more patients are learning about this “patient right” to avoid spending more at the doctor’s office.

When a patient arrives in your office, after the “hello” the first question usually asked of them is, “what is your insurance”. That disclosed the cost of the visit will be the maximum that the insurance company allows. Furthermore, that number is often higher than many physicians will willingly accept. “Your insurance rate for this visits is…. $$$$” And since the patient is likely in the deductible period, that cost is expected to be paid in full by the patient.

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In response, many patients are seeking to exercise a right under amendments passed to HIPPA the Health Insurance Portability and Accountability Act (HIPAA).

There is a provision in HIPPA that give patients the right to request to make personal payment for medical services, then and there. They are willing to pay a visit fee, not billing the insurance. And of course, the patient is asking for a cash price. Have you considered what your “cash” price is, paid in full at time of visit? No billing, payment directly from the patient at the time of services.

Most medical practices willingly discount their services in return for payment at time of service directly from the patient.

When a patient makes this request, which they have the right to do, and they pay for the service themselves, in addition to requesting a lower cost, their medical record for those services are precluded from being reported or available to their insurance carrier.

This regulation was created to protect the privacy of the young adults who under health reform were now covered under their parent’s policies, but did not want their parents to know such things as abortions, or birth control prescriptions. Why a patient invokes their right to request this HIPPA provided option, is not subject to question.

It is a right you have under the law, and your patient can use it to request to pay cash and seek a discount on your fee to pay at the time of service.

Now there is a downside for the patient– a risk. If later in the year the patient encounters a major illness? Unfortunately, what was paid during your deductible using this technique will NOT be counted towards their deductible; the patient will have to meet their full deductible using additional payments. This is the risk to the patient. If the patient is in the 11%, 3% or 2% noted above, and chooses to use this technique, they will be paying in essence twice.

However, if your patient is in the 89%, 97% or 98%, and they execute the powers HIPPA bestows upon them rightfully, this makes your revenue collection easier, paying cash at the time of service. Moreover, the patient becomes ahead.

Many offices are not aware of this HIPAA right, although most are more than willing to offer a cash discount. So, you need to plan for the question, “can you offer me a discount on that fee if I pay cash now?” Be ready with a cash price, paid at the time of service.

No insurance company is going to tell the patient or even confirm with your office regarding this “HIPPA right”, but HIPPA is a Federal law, and it’s the patient’s money and a legitimate business transaction. In essence, the patient is becoming self-pay for the visit.

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About Author

Alex Tate

Alex Tate has served in various positions at leading health IT organizations for the past thirteen years. Most recently Mr. Tate served as Vice President at a leading EHR organization. He currently oversees product management and revenue cycle consulting for a number of organizations. Mr. Tate oversaw the development of many emerging products and held leadership roles across health-tech strategy, operations, service organization development, delivery and optimization. His ongoing collaboration with startups and academic research centers are paving the way for the development and commercialization of groundbreaking technologies like artificial intelligence, augmented reality, HCI and other initiatives for a future that offers the promise of transforming care delivery through cutting-edge technology and progressive methodologies. You can reach him at alextate07@gmail.com

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