Doctors Lose Billions in Uncollected Co-Pays


Anyone who has ever managed a medical practice can tell a familiar story; it can be difficult to collect what a practice is owed beyond the co-pay collected at the time of visit.  Given the complexity of the myriad private payers with which medical practices interface, it can be almost impossible to ascertain what is owed in terms of deductible prior to the patient’s visit.  As mentioned in a July 2009 article by Anne Zieger, the consultancy McKinsey & Co. has estimated this annual total at between $14-30 billion.  It is suggested that real-time claims estimate technology can allow the front office to make sure they know what the practice will be owed at the time of visit, but right now most practices do not make use of it.  Instead, once the claim disposition is received from the payer, the practice attempts to collect the remainder due. 

This problem is likely to increase since higher-deductible plans are becoming more common, in order to avoid the higher premiums which would otherwise be required.   High deductible plans shift more of the cost onto the patient.  With uncollected deductibles, costs are shifted onto providers as well.  One simple solution, although not allowed under current provider-payer contracts, is to simply reserve appointments with a credit card, in the manner of a hotel.  Any deductible due can be simply billed to the card.  This isn’t a perfect solution, but it would be far simpler and less costly (in the short term) for practices to implement this kind of policy.  Rather than installing complex real-time technology to collect what the practice is already owed, they can make sure that they get it in full at the time of service. 

For non-participating providers, the credit card hold policy is an option.

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