The vast majority of medical and dental practices accept at least some form of insurance. Insurance billing issues trouble many health practitioners, and some issues result in delinquent patient balances. Medical debt collection, already not an easy task, is even harder with the advent of large deductible programs, which require patients to pay more out of their own pockets.

Our client, a Connecticut medical group was experiencing an increase in delinquent patient accounts due primarily to two factors:

The first issue was a result changes in insurance policy deductibles and limits on coverage. Many patients are feeling the pinch of larger deductibles and other cost sharing, such as coinsurance. While some of these changes are the result of the Affordable Care Act, most changes have been in the works for years. Many patients were having difficulty paying the large deductible amounts, and more files were being referred to collections. 

The second issue had to do with the fact that the physicians who ran the group made a decision not to participate with certain insurance companies, for a number of reasons. When our client went “non-par” (also referred to as “out of network”) with an insurance company, they are were not bound to the contractual pricing of the insurance company. Our client still billed patients to the non-par insurance companies, and decided to accept whatever insurance paid the patient. However, in the new arrangement insurer sent payments directly to the patient. More and more patients were getting large checks and rather than sending the money to the doctor’s office, they used the money for other purposes, and then had no way to pay the doctor.

Although our client was very willing to work with patients, offer health care financing or payment plans, they simply could not afford the increasing number of delinquent accounts they were seeing, and they asked for our help.

We helped our client by putting together two new patient forms. The first form was a patient insurance form used for new patients or patients with new insurance. A billing manager would review the form with patients, and make certain they were aware of any coverage limitations and/or deductible provisions. Patient would sign the form and acknowledge that they were responsible for any sums not covered by insurance. 

The second form was a notice to any patient with a “non-par” insurance company instructing them that the doctor would accept whatever sums the insurance accepted as long as the patient remitted the insurance check within 30 days. If the patient failed to remit the insurance payment within 30 days, payment of the full balance (not just what insurance allowed) would be due and owing. 

Our client had been telling patients this information but it was not until they put everything in writing that they were able to drastically cut down on delinquent patients. Their attempts to minimize bad debt continue to be successful. 

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