So stop me if you heard this one you go to physical therapy for 2 to 3 months the whole time you’re not paying a copay not paying a coinsurance. About a month or so after therapy, you get a bill for $500 sometimes $2,000 plus. it also comes with a note saying that you have 90 days or 30 days to pay it. Now I know some people out there can see a $2,000 bill and not sweat it but not me. If you grew up like some of my friends and see a bill like that, you begin to fear that you’re going to have to go back to eating wish sandwiches.
“Why didn’t they tell me my bill was going to be that high?”
”How in the Sam Hill did they let my bill get that high. What makes them think I can afford that? “
Then you realize the new year has started over, and insurance has struck again. Most of us forget that at the beginning of a new term usually at the beginning of a new year. your insurance starts all over so all the co-pays that you have paid all the money that you have put down towards your deductible and the last year do not carry over into the next. So a service that may have been free at one time it’s no longer free because your deductible has not been met. That means you start over again with each and every office visit meaning more out of pocket. Depending on your insurance you may have a copay or coinsurance or a secondary that’s going to take over part of it so a lot of times the office doesn’t know what your amount will be so they’re just giving you a rough guesstimate.
Also, there are times when the insurance company says that the services are covered then they send you a letter stating they aren’t. The patient is now on the hook for that amount. This happens with a couple of the insurances more often than it does with others but I’m not one to gossip so we’re not going to name no names here.
Nothing makes a clinician or front office person feel worse than finding out that a patient they enjoyed working with is now stuck with a big bill. Most of the time a staff clinician doesn’t know how much their company is contractually billing the insurance company. This means that they don’t know how much the patient may be on the hook for beyond the copay. I remember the first time a patient showed me the remittance letter that they received from their insurance company. I saw how much was billed for that hour. I also saw how much the billing company paid and how much the patient was on the hook for after the deductions. Let me tell you I was in shock when I realized I wasn’t even making a third of what I billed that patient.
I came to learn that the insurance companies set up contracts with medical providers where they are allowed to make reductions in the bill. The insurance company comes up with fee schedules where they will only pay a certain amount for each service if THEY deem it necessary. “So why wouldn’t the healthcare provider just bill what the fee schedule said they will pay?” Well, not all insurers have the same fee schedule. On top of that, there are times when the set amount on the fee scheduled is paid less than what is in writing.
If this sounds confusing and stressful it is. Billing a lot of times is the worst part of a clinician’s job. you don’t want to set your prices too high and make it so that patients can’t come to you but you also have to make it so that you are covering your overhead and that you’re able to live and eat and pay your bills with what you’re taking in.
That is why a lot of providers are starting not to take insurance now. It is just too much of a headache. Many times the patient ends up owing more than if they would have gone the cash pay route. There have been multiple times when a patient had to pay me more than my cash pay rate. Say my cash pay rate is $75-100 for each visit no matter how long I see you that day. You know you’re paying each visit. Time and what is done in that time is a big factor in how insurance pays the bill. One visit the patient’s out-of-pocket could be less than $50. Another visit where more was done with the patient for a longer time will cost more. Couple this with the patient who is using their insurance coming to therapy more because hey a $30 copay may not seem like such a big thing so they want to come more than the person paying $75-100 because they don’t realize that they may have to still pay more on the back end.
Something that you can do is make sure you have a clear understanding of what your insurance company is going to cover. Also, know how close you are to meeting your deductible. If you know that you have a co-insurance pay a little bit, maybe $20, every visit, so that at least part of that bill is cut down before you end up with sticker shock. Also, make sure you check in with the clinic about every 2 weeks to see what information they may have been given from the insurance company.
Fearless Physical Therapy PLLC 