Over the past decade, out-of-pocket healthcare expenses have more than doubled for the average American. Many people are choosing high-deductible health plans in order to save on monthly premiums, but this change puts a higher burden on their wallets when it comes time to go to the doctor or fill a prescription. Doctors have been slow to change their internal billing practices in the past, but now they find themselves swimming in a sea of their own unpaid bills. Many providers are switching to point-of-service collections to curtail their losses, asking patients to pay for services before leaving the office. While the movement may not make everyone happy, it may be the only way to keep doctors in business. Show
What are Point-of-Service Collections?There are many interpretations when it comes to point-of-service (POS) collections. Doctors and hospitals may refer to their POS collections as time-of-service, upfront, or front-end collections. In general, a provider who participates in POS collections will ask for payment of a proposed service sometime before the service is rendered, up to the time the patient is discharged or leaves the office. POS collections ask everyone to pay, from patients who pay solely out-of-pocket to those who are insured and need to pay either a deductible, copay, or coinsurance amount. POS collections can also include prior balances or payment plan payments. Most hospitals and medical providers who conduct POS collections accept cash, checks, and credit card payments. Why Does My Doctor Want Money Upfront?With insurance premiums and deductibles continually rising, more and more Americans are having trouble paying their medical bills. According to the Academy of Healthcare Revenue, providers have a 70% chance of receiving payment at the time of service if they request it – but only a 30% chance of collecting it after a patient leaves the building. Since so many people are unable to pay their balances, many providers have started to question if they can even stay in business. The reimbursement rates that doctors receive from insurance companies are also constantly changing. When you combine this reimbursement uncertainty with patient non-payment, many providers are left struggling to pay their office bills. Office space, utilities, technology, medical equipment, and staff are all necessary for patient care – but these items all cost money. By moving to the POS collection model, providers are finding that they can spend less time billing patients and more time treating them. Many doctors and hospitals are even adopting payment plans as a way to help patients cover costs, similar to other industries that deliver higher-dollar products and services. While some patients may dislike the trend, it is allowing doctors to stay in business. How Does My Health Insurance Work?The traditional model of copays is quickly going out of style. Most patients now deal with health insurance that features either a high deductible or coinsurance – or a combination of both. Deductibles and coinsurance do not negate monthly premiums, though; they are paid on top of them.
The Comprehensive Primary Care PolicyAt CPC, we ask our patients with policies featuring annual deductibles to pay $100 on the day of their office visit. This $100 goes toward paying down the patient’s out-of-pocket costs associated with the visit and also contributes to paying down the patient’s deductible as a whole. Once a patient can show us that they have met their deductible for the year, we no longer collect the $100. Annual physicals are also not subject to this fee as long as patients follow the guidelines set forth by their insurance plans. We have decided to implement the $100 POS collection fee for several reasons:
We understand that rising medical costs can make health care seem unaffordable for some people. CPC is committed to helping our patients ease this burden in whatever way we can. With our $100 POS collection, we can save money on billing services – keeping the prices for our services down for our patients. We want everyone to receive the highest-quality care available, and we will help you with insurance claims whenever we can. If you have any questions regarding your personal insurance coverage, feel free to contact us at any time. Let CPC help with your health in well-being in 2017; set up an appointment today!
Health insurance protects you from financial losses due to illness or injury. In exchange for your payments, known as premiums, your insurance company promises to pay for some or all of your health care services. Health Insurance Terms
Difference Between Co-Insurance and DeductibleIf your health insurance company says a covered benefit “applies to deductible and co-insurance,” you must pay the amount of your deductible. Your deductible is a declining balance. You must pay the amount of your deductible before your insurance company begins to reimburse you for medical expenses. After you have paid your deductible, then you only need to pay co-insurance, or a portion of your medical expenses. Your health insurance company pays the rest. Under most health insurance plans, there is a limit to the amount of co-insurance you have to pay. This is known as an “out-of-pocket maximum.” In general, you pay your deductible and co-insurance directly to the doctor’s office, not to the insurance company. Co-Pays or Co-PaymentsYou pay a co-pay (or co-payment) at the doctor’s office. A co-payment is a fixed amount of money that you pay when the doctor delivers (or renders) services to you. Co-pays DO NOT count toward your deductible or co-insurance. Depending on your insurance policy and on the kind of doctor you see, the amount of your co-pay may not always be the same. For example, you might pay a $20 co-pay to see a Family Practitioner, but you might pay a $50 co-pay to see a specialist, such as an Oncologist. In general, if the doctor’s title has “ist” at the end, the doctor is a specialist and not a primary care doctor. Example In-Network Claim Under UNC System Health Insurance Plan (Deductible Not Yet Met)If you have not yet met your deductible, the example below illustrates how your claim might break down. The dollar amounts in this example are for illustrative purposes only. Actual dollar amounts will vary depending on the service(s) you receive and the provider(s) you see:
Explanation of Above ClaimBecause you pay a co-pay at your doctor’s office visit, your co-pay is deducted first: $250-$20 = $230. Next, your deductible applies: $230-$200 = $30. Your co-insurance applies next. You are responsible for 20% of $30, or $6. Your insurance company is responsible for 80% of $30, or $24. Therefore your total responsibility is $20 + $200 + $6 or $226. Example In-Network Claim Under UNC System Health Insurance Plan (Deductible Met)If you have met your deductible, the example below illustrates how your claim might break down. The dollar amounts in this example are for illustrative purposes only. Actual dollar amounts will vary depending on the service(s) you receive and the provider(s) you see:
Explanation of Above ClaimBecause you pay a co-pay at your doctor’s office visit, your co-pay is deducted first: $250-$20 = $230. Because you have met your deductible, your remaining balance is $230. Your co-insurance applies next. You are responsible for 20% of $230, or $46. Your insurance company is responsible for 80% of $230, or $184. Therefore your total responsibility is $20 + $46 or $66. Example Out-of-Network Claim Under UNC System Health Insurance Plan (Deductible Not Yet Met)If you have not yet met your deductible, the example below illustrates how your claim might break down. The dollar amounts in this example are for illustrative purposes only. Actual dollar amounts will vary depending on the service(s) you receive and the provider(s) you see:
Explanation of Above ClaimBecause you pay a co-pay at your doctor’s office visit, your co-pay is deducted first: $250-$20 = $230. Next, your deductible applies: $230-$200 = $30. Your co-insurance applies next. You are responsible for 30% of $30, or $9. Your insurance company is responsible for 70% of $30, or $21. Therefore your total responsibility is $20 + $200 + $9 or $229, but you may owe more money if the doctor charges more for a service than the insurance company allows. Example Out-of-Network Claim Under University-sponsored Health Insurance Plan (Deductible Met)If you have met your deductible, the example below illustrates how your claim might break down. The dollar amounts in this example are for illustrative purposes only. Actual dollar amounts will vary depending on the service(s) you receive and the provider(s) you see:
Explanation of Above ClaimBecause you pay a co-pay at your doctor’s office visit, your co-pay is deducted first: $250-$20 = $230. Because you have met your deductible, your remaining balance is $230. Your co-insurance applies next. You are responsible for 30% of $230, or $69. Your insurance company is responsible for 70% of $230, or $161. Therefore your total responsibility is $20 + $69 or $89. Please contact the Student Health Insurance Office if you have any questions at: or 919-515-2563. |