BILL PAY
Billing Basics
In case you haven’t noticed, pretty much everyone is in some degree of economic distress these days—particularly in Michigan. This includes insurance companies, the employers (i.e., auto companies) who hire them and the government—which, of course, includes Medicare. Consequently, there are more rules, less benefits, more overall scrutiny and greater enforcement of the rules that relate to your health insurance.
How does this affect you? It means that it is no longer possible to bill things in, let’s say “creative” ways that will result in insurance coverage that is not actually a covered benefit in one’s plan. Today, this is viewed as insurance fraud. Think of it as paying your taxes—you do everything legal to lessen your tax burden and we too will do everything legal to maximize your insurance coverage. Still, deductibles and co-pays are higher, benefits are less. Efficiency is now the key goal and we will do everything we can to maximize efficiency while preserving the very high quality of care that we provide.
Paying Your Bills
For three decades our practice allowed patients to make partial payments on their outstanding balance. When there was enough money available to keep the practice afloat, we were happy to make this accommodation. As a mostly Primary Care office we are the least remunerated and most economically vulnerable specialty. We think this is unfair, but it is the hard truth. For all the talk that this needs to change because primary care is so vital to the nation—that’s all it is—talk. Although we are about as successful as a primary care practice can be, particularly in Michigan, we are operating on slim margins.
We follow the health care industries standards on billing and collection of accounts receivables including careful tracking of all bills and billing related communications. On-line bill pay is automated and state of art in our system. Then we go much farther. We offer many services in our office for your convenience including many that are not profitable for us. We bill your primary insurer for services provided. We participate in nearly all health plans including many that are economically unfavorable to our office. We follow the same protocol for all patients with outstanding bills and send multiple bills to patients with unsettled accounts. We offer payment on a number of credit cards (Visa, Master Card, Discover and AMEX) and even send out a “last chance” letter by U.S. and registered mail in the hopes that patients will settle their bills and allow us the honor—and it is an honor—to continue to be your doctors. Although rare, after our accounts receivable process is exhausted including several mailed letters, calls and final warnings, we will discharge patients from the practice for non-payment. Ultimately, we cannot assume the responsibility of a bank and “carry” accounts receivables. We simply cannot afford to see patients and not be remunerated and keep the office running. Those days, sadly, are gone.
Wellness Billing
Many plans including Medicare do not pay for comprehensive preventive visits. If that is the only reason for a visit, you will likely be responsible for the full amount. If there are secondary diagnoses and we have also billed a regular office visit, you will be responsible for well visit minus whatever insurance paid on the other visit. As stated above, we take every liberty to bill your insurer aggressively but legally for our services. In the end, however, there are limits to your insurance coverage. Again, we must bill both the preventive visit and the symptomatic visit which will generally LOWER your-out-of-pocket expenses. These are CMS (Federal Government) rules and Insurance rules, and we have no ability to disregard them.
