[August 17, 2008]

Time to pay the doctor -- right away

(News & Observer, The (Raleigh, NC) (KRT) Via Acquire Media NewsEdge) Aug. 17--As health care costs get higher and workers are asked to carry more of the costs, high-deductible insurance plans are getting more popular.

But many people are finding an unexpected cost: Doctors expect their full payment upfront.

After years of paying $20 or $30 copayments, some people are having trouble adjusting to the idea of handing over $150 or more before they leave the office.

"There is a cultural shift," said Cameron Cox III, president of Triangle Medical Managers, which represents about 95 medical offices throughout the Triangle. "For a long time, people kind of got use to going to the doctor's and filing a claim. Now it's like we want the whole bill upfront."

Doctors say they need to collect the money upfront -- rather than bill people -- because they want to cut back on costs associated with collecting payments.

Doctors feel they have little choice but to collect the money up-front when they know the insurance company will not be making a payment.

"We like to provide a service," said Dr. Conrad Flick, who has a Raleigh family practice and is the chairman of the National American Academy of Family Physicians Commission on Governmental Advocacy.

"We are like any other business. We have to collect our money to pay our bills. It's far easier to collect upfront than to go after someone on the back end."

But Cox said that many consumers don't understand the new high-deductible health plans, which offer lower monthly premiums in exchange for paying deductibles of $2,000 or more. Often, people are not sure which visits are covered and which are subject to the deductible.

In addition, Cox said that in the past people have gotten away with paying less because it was harder to know whether they had met their deductible or not. But technology has since improved. Now it's much easier for medical administrators to go online and check, Cox said.

This can be a problem for patients with two or three doctor visits in one week. If each requires the full payment, it's possible to overpay the required deductible and have to seek a refund.

"It's reasonable to go [an] eye doctor on Monday and then visit other doctors on Wednesday and Thursday, and there will be an overpayment," Cox said. He said that doctors will refund the money, but the patient has to figure out which practice actually owes the refund based on when the claims were filed.

There are some things people can do to better navigate in this new high-deductible health insurance environment.

--Know the terms of your policy. Find out what your deductible is and keep track of your medical payments so you will know when it has been met.

--Talk to your insurer about whether you're eligible for a Healthcare Savings Account. The funds contributed to the account are not subject to federal income tax at the time of deposit, or when they are used to cover medical expenses. Unlike a Flexible Spending Account, funds roll over and accumulate year over year if not spent. The account is owned by the individual, not the company.

--Get your doctor's office to estimate the cost of your visit before you go in. Some do this automatically to avoid surprising patients with a high bill.

--Try to find a doctor who will work out a monthly payment plan for people with chronic illness. For example, at Access Health Care in Apex, Dr. Brian Forrest does not accept any insurance. The practice's costs and fees for various treatments are posted in the office lobby, Forrest said. Patients who require continuing treatment can pay $25 a month plus $20 per visit. That would cover all lab work and any in-office procedures, Forrest said.

--Finally, become active in maintaining your health. Talk with your doctor to get tips on how to care for yourself and reduce future medical bills.

vicki.parker@newsobserver.com or (919) 829-4898

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