More Doctors Demand Payment Upfront

If you’ve been to the doctor’s office lately, chances are that you’ve spotted a sign saying “payment is due at the time of service.” Or perhaps the receptionist has expectantly held out a hand for a credit card when checking you in.

When it’s a $25 office visit copay, no big deal, right? But what if it’s a $2,500 copay for a surgical procedure — or a $1,000 deductible for an emergency room visit?

More and more doctors’ offices and hospitals are demanding share of cost payments in full up front, according to Kaiser Health News. That’s not good news for patients, especially with an uncertain future for health care in America.

While this may sound cold, from the perspective of the medical community, it’s simply good business practice. The higher the deductible, the lower the probability that the patient will pay a bill in full. And that leaves clinics and hospitals holding the short straw.

Unpaid bills can quickly drive up operating costs, so they must often be passed on to other patients. After all, someone has to pay staff, maintain equipment, stock medications and supplies, manage costs associated with licensure, bill insurance companies for their share and perform the myriad other tasks of keeping a hospital or clinic open.

To ensure that they’re not caught short, many providers ask for the money patients owe in advance of services.

For a basic office visit, that’s not a big deal. Office copays are usually fairly low and established very clearly in a patient’s insurance contract — no one’s going to dispute this particular share of cost.

It gets more complicated as copays get bigger, though — for two reasons.

One is the sheer amount of money involved. Many patients don’t have several thousand dollars — especially in an emergency — and struggle to cover copays up front, although they might be able to work out a payment plan with a health care provider. For scheduled, planned events it’s frustrating to suddenly be slammed with a deductible, but in a crisis, it can be dangerous.

Kaiser Health News notes that under the law, emergency rooms are required to provide care to patients with urgent medical emergencies, and cannot discuss payment until patients are stabilized. Some, however, appear to be entering gray areas, demanding payment for emergent, but not urgent, health care problems.

Patients in crisis may not even have cash, checkbooks or credit cards on them when they rush to the hospital, let alone enough money to cover a large emergency room copay. Thanks to the economics of health insurance, many people who have trouble affording copays in the first place also have low cost insurance policies with high deductibles and shares of cost.

There’s another problem, though, and it lies in disputes with insurance companies.

While some aspects of care are clearly documented in insurance policies, others are more nebulous, and patients may end up disputing some bills. In certain cases, they may prevail, with the insurance company actually owing all or part of a bill that was directed to a patient.

The problem is that if the patient has already paid that share of cost — as, for example, in an emergency situation — it can be difficult to force the insurance company to reimburse the patient. The health care provider no longer has a stake in the matter because they’ve been paid already, making them unlikely to help out.

Currently, an estimated three quarters of medical office requirement payment in full at the time of service. If changes to the Affordable Care Act increase the number of uninsured people — potentially to as many as 59 million if the ACA is repealed but not replaced — this could have a huge impact on the ability to access health care