Phacolens

New Member
Feb 25, 2017
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To those in private practice:

Do you collect upfront when a patient's insurance deductible has not been met yet? Let's say a patient comes in for a first time visit for a comprehensive eye examination and you bill using 92004 (New patient, comprehensive eye examination)

Consider these two scenarios:

Scenario 1: Patient has a 4K deductible for the year which hasn't been met. You collect $200 up front, render services, then bill insurance. EOB (explanation of benefits) gets posted by insurance and the cost of the visit is 175. So you owe the patient 25. You can cash them a check or use it as credit for a future visit.

Scenario 2: Patient has a 4K deductible for the year which hasn't been met. You don't collect up front, render serves, then bill insurance. Patient now owes you 175. You send a bill to the patient and it is ignored. Send multiple bills and the same ensues. You can now send the patient to collections and patient is guaranteed to not return to you. More importantly, you've provided a free visit and lost 175.
 

MstaKing10

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10+ Year Member
Aug 18, 2009
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This should be discussed prior to their visit upon investigation of their insurance benefits. Then when the patient arrives they should know exactly what to expect. We tend to collect up front to avoid scenario 2. Not only is there a chance they don't pay but surprising them with a bill is usually not a good business practice. There is of course many other scenarios, for example you bill up front but then further testing is needed (i.e. OCT, etc). Now you bill the insurance and despite them having paid up front you will still have to collect on the back end.

These high deductible plans can be a real bear, especially the low premium variety. Those with high deductible HSA type accounts tend to work out a little better. What do others think? Good question
 
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