2020 Changes in How and When You May be Billed at the Doctor’s Office

Medical service providers may now require patients to pay a portion their office visit on the same day of service before billing to insurance.

I recently visited a dermatologist for my annual skin exam. I was expecting business as usual until the administrator told me that since I had a High Deductible Health Plan (HDHP) I would be required to pay 50% of the bill before leaving their office. The patient billing practice had been recently updated as of January 1, 2020.

Unfortunately, the office administrators couldn’t tell me how much the visit would cost until after their services were rendered. This means that I would be required to pay some arbitrary dollar amount the same day without the opportunity to ensure that funds were available to make that payment or even call my insurance provider.

This new billing method of collecting at the time of the office visit could put consumers in a very tough position when they visit their doctor, especially if the services needed were time sensitive like an injury or something else reactive in nature (true emergencies have to be treated by law, regardless of ability to pay). Based on comments from insurance carriers, patients may start to see this billing practice implemented more frequently.

Here’s why you may start to see this trend with healthcare providers:

The provider incurs expenses at the time of service, and they want more timely payments than the standard billing practices would normally provide them.
HDHP medical insurance plans don’t normally pay the service provider unless a patient’s deductible has been met and out-of-pocket maximum has been fulfilled.
If you go to the doctor in Q1 of a new year, the provider will likely (and often, rightly) assume the insured hasn’t met this year’s deductible and aren’t even close to the out-of-pocket maximum stated in the plan documents.

The standard billing practice at most doctor’s offices is for the patient to only pay a co-pay (if required) at the time of service. The provider then bills the insurance company directly. The carrier then applies any negotiated in-network discounts and calculates what portion of the charges should be applied toward a deductible and out-of-pocket maximum. Within a reasonable amount of time, the insured (patient) and the doctor’s office will receive a billing statement detailing:

Services rendered to the patient from the service provider
What was discounted by the insurance company
What was paid to the provider by the insurance company
Any outstanding balance that is due and payable by the insured (patient)
What of that amount is applied to the in-network and out-of-network deductible
What of that amount is applied to the maximum out-of-pocket

Key takeaways

Your employees may need some advice when faced with this new billing practice. Be sure you prepare them by sharing the following tips:

Call the doctor’s office and discuss the billing process prior to each and every visit as their procedures may change.
Speak with the insurance provider to understand your co-pay and any other upfront cost requirements
Get updates on where you sit with respect to your out-of-pocket maximums and deductibles.
Check HSA and/or FSA accounts balances, when applicable.

Knowing there may be an increase in up-front healthcare costs, now is a great time to educate your workforce on the advantages of FSAs. Check out our e-book to get a head start.