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Rising Deductibles

  

  

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RISING DEDUCTIBLES COULD CAUSE “STICKER SHOCK” AT TIME OF SERVICE. As almost every group health insurance plan has or is going to face a price increase, employers are looking for ways to stabilize annual increases and maintain benefits. One of the more common methods to reduce overall premium cost is to increase deductibles and/or copayments. Many plans are able to retain copayments for doctor office visits and pharmacy, but are dropping copayments associated with out patient testing and diagnostics. This has led to a practice in the medical community that can be very disturbing to employees covered under group insurance plans as well as individuals who have been forced into the high deductible market due to premium affordability. What is happening is the way that contracted providers have been allowed to collect for services.

A classic example of this would be the person who has been scheduled to receive an MRI at a contracted provider under their insurance plan. If there is no copayment for this service, many times the individual will be asked pay the contracted rate at time of service. The practice in my area is to call the patient 24 to 48 hours prior to the appointment, to both confirm the appointment time and date and let them know that they will need to bring $1,000 (using the MRI as an example) with them to pay for the service. The provider indicates to the patient that they have received the contracted rate from the insurance carrier and this is the amount that will be due for the service. If you have a fully funded HSA, this is no big issue as you would swipe your HSA debit card and go on your way. If not, the insured is now in the position of  dealing with the stress of the diagnostic test and it’s outcome,  as well as having to find a large sum of money in a very short time to pay for the service in advance.

There are two reasons this really rubs me the wrong way. First, is the historical perspective. We have all received medical services, then the provider files the claim with our insurance company and we pay the balance due to the provider when we receive our Explanation of Benefits from our insurance carrier. As an insured, this has always been the process and therefore is the expectation for the majority of individuals. In an effort to protect their bottom line, certain providers in the medical community feel that it is OK to request payment in full at time of service. Most network contracts allow this practice, however it certainly would be more professional and ethical to indicate to the patient AT THE TIME THE APPOINTMENT IS MADE that payment in full is expected at the time of service. I can assure you, that in the vast majority of cases, the referring physician is not aware that this practice is occurring.

It is now imperative that you educate your clients on this practice and make sure that if they are sent for services that are deductible eligible and their deductible has not been met, they could be asked to bring the amount that will be due with them. If the testing is in a non-emergency environment, many times the insured can avoid this pre-payment foolishness by simply going to a network directory and finding a provider that has not adopted this practice.