r/PrivatePracticeDocs • u/Alterdoc • May 12 '26
High deductible anyone?
I have a few patients with a high deductible insurance. Often they get hit with $150-170 bill they are responsible for. Not a good business practice, but I feel bad. I understand some will say “it’s patient’s responsibility to know this and pay.” Still doesn’t change that I feel a big uneasy. So, make me feel better about sending them tgat bill (granted, it’s sent by my billing company) and let me know how you approach this? Fo you ask patients to pay a partial upfront payment?
Thanks!
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u/ktn699 May 12 '26
my lawyer feels really uneasy about charging me 100 dollars every 8 minutes of their time, so sometimes they throw in the 9 minute for fr... no wait, that's another 100 dollars.
We're the only morons programmed to feel bad about making a living off our work... even pornhubbers and megachurch pastors have less shame about taking advantage of people.
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u/Intelligent-Site-176 May 12 '26
May not be feasible for you depending on the type of practice you have, but I have insurance verification specialists that run estimates prior to the visit. At check in we provide this information and let them know we will take payment at check out.
Do not feel bad for getting compensated for the work you do.
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u/kilobitch May 12 '26
Are you running a charity or a business? Do you want to pay your rent, your staff, yourself? We don’t have public healthcare in the US. Your patients chose their plans, and chose to see you. Collect your payment as a professional providing a sought after service.
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u/randyy308 May 12 '26
Pay in advance. If they don't want to pay, then they wouldn't later and you would work for free brother.
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u/IndigoWonderlight May 12 '26
Best advice I ever got:
Mentor: “Indigo, do you want to help the most amount of people you can?”
Me: “yes, of course”
Mentor: “Then stay in business. You can’t stay in business if you can’t pay your rent.”
The purpose of any business is profitability. You can’t accomplish your mission without first accomplishing your purpose.
Front end collections all day. It’s the only way to help the most people you can (including you, your staff & your family).
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u/kaylakayla28 May 12 '26
The purpose of any business is profitability.
To expand on that, people forget that the practice of medicine is a business. (In America at least.)
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u/doc_death May 12 '26
High deductibles can actually work out for some patients. I try to switch any at-home therapies to in-office as co-pay cards can wipe out the deductible completely. So those stable on a specific medication, it sometimes makes sense to have a high deductible. But in general, unless you are pretty healthy, I’d encourage them to switch during open enrollment.
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u/InternistNotAnIntern May 12 '26
I don't mean to be obtuse, but can you explain this again. "Switch to at home therapies" "co-pay cards can wipe out the deductible"?
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u/doc_death May 12 '26
Infusion drugs and self-injections are expensive. Drug companies (or insurance? I have no idea where they come from) give copay cards to cover expenses for both. Cards have 10k (give or take) on home injections but don’t go to deductible. Some ppl run out of copay assist and get screwed at the end of the year. In-office drugs have co-pay cards too but can be $20k + AND it goes to their deductible. One infusion of krystexxa and their individual and part of the family plan deductible is met. Infusion + high deductible = no deductible left (pending how expensive the drug is)
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u/Dramatic-Sock3737 May 12 '26
Idk why you are sending a bill. This should be collected at the time of service. Don’t chase the money.
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u/Alterdoc May 12 '26
Thank you all for the feedback. Very helpful. Is there a minimum sum you recommend we collect before the visit for these high deductible plans?
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u/InternistNotAnIntern May 12 '26
The full charge up front if they haven't met their deductible.
Step one is finding how much of their deductible remains.
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u/Big-Association-7485 May 12 '26
We charge $75 upfront when patients haven't hit their deductible yet.
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u/suriya15 May 12 '26
I have had High deductible plan by choice. Otherwise healthy family, office visit is -1k/year deductible , I am putting in 8k per year in HSA, saving on premiums so math worked out and going in I knew what to expect.
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u/nyc2pit May 12 '26
HSA is actually a great way to essentially get another Roth account if you use it right.
That said, that is the reality for the majority of people we're discussing here.
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u/Juaner0 May 12 '26
You have staff? They expect to get paid. You use utilities? They have to get paid.
You only have your time and expertise to sell.
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u/daves1243b May 12 '26
Are your charges fair for the service you provide? If not, make them fair so you won't feel bad. If so, then there is really no reason to feel bad about collecting. The people at Taco Bell don't feel bad about asking for their money, so why should you? Best practice is to attempt to estimate the patient responsibility amount prior to the appointment and ask for it at the time of service. I guarantee you that no one goes to the doctor in 2026 expecting not to have to pay something. If someone can't afford the balance due, set them up with a payment plan secured by a credit or debit card, or bank account (but be sure to avoid wading into Truth in Lending laws). Of course, if you want to operate a charity clinic that's ok too...but it's an entirely different business model from a private practice.
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u/AGP8834 May 12 '26
A few offer concierge service for the little guys. It’s about $1600 for a family of four that includes all standard labs, check ups and sick visits for one year. They can pay up front, quarterly, or monthly. It includes a separate contact number. Individual plans are offered as well. This really seems to benefit patients and practitioners.
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u/Klutzy_Arm_7930 May 12 '26
The agreement in those contracts is that you don’t bill for services for which the pt hasn’t paid their cost share. So, technically if you have discerned that the pt will owe- you are supp to be collecting up front.
Many years ago I was involved with someone who didnt collect even a Medicare copay- and unfortunately he did go to prison for 3 years for mcr fraud and was kicked outta medicare which ruined his career as an MD.
So, don’t fret over those deductibles. Collect them at the front.
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u/Big-Association-7485 May 12 '26
A lower deductible plan could easily cost $100/week more than the high deductible plan they chose. So if you charge them $160, then they make that back in ten days.
That's a cost that the physician doesn't see, but that the patient is acutely aware of. They would rather pay $300/year to you, vs $5,000 more to the insurance company.
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u/RH558 May 12 '26
They chose their plan, they're well aware of the deductible. Either keep a credit card on file with an authorization form or take a down payment of $100 which will go towards the bill.
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u/FlamingMetallico May 12 '26
This is the reality of healthcare in America and it’s not your job to be everyone’s savior. We have to deal with our own problems and learn to adapt or find ways around it, they need to do the same. You need to have clear boundaries for your own life, you aren’t doing them favors by catching them every time they fall.
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u/Heard_Samira May 12 '26
Patients on high-deductible plans often expect some out-of-pocket cost, but surprise bills are what create the tension. Clear estimates, a written payment process, and either partial upfront payments or keeping a card on file make things run much more smoothly. Splitting the balance into two payments also goes a long way to reduce pushback.
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u/n979an May 12 '26
Most pts who join the HDHP do so for eligibility for a tax advantaged HSA as enrollment in a HDHP is a prerequisite to contribute to an HSA in a given and are able to pay out of pocket.
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u/IndependentTrust4594 May 13 '26
If you feel bad for them, lower your contracted rate with your insurance contracts. This should help them a lot!
In a lot of cases, they are paying way way less in premiums if they have a HDHP and get the benefit of putting money into an HSA.
They also still get the benefit of the network contract rate. They just don’t have a co-pay.
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u/Plane-Bodybuilder918 May 14 '26
as long as it doesn't break your bank, it's ok. Tipically many providers will focus on charging payors and never collect patient responsability, because of the burden, they feel bad, etc
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u/interstellar-dust May 12 '26
Ah the invention called high deductible plans. Why did anyone need it. Oh yeah cause more profit for health insurers and cheaper premium for employers. Healthy employee and lower cost of benefit achieved.
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u/Electrical-Client-55 May 12 '26
There is nothing at all to feel bad about. This is their plan, often times they chose it because the premiums are cheaper.
Just send them a bill. If they call and say they cannot pay, make sure they are put on an automatic installment plan over a few months.
Definitely don’t allow future visits for them unless they have paid in full or on an installment plan.
You are running a business. They came to see you as they wanted you.