March 4th, 2009

Reports the Washington Post:

More and more physicians are asking for the patient’s share of that day’s medical fees, including any deductible set by the insurer, at the time of the visit.

“It’s a paradigm shift from what most consumers are used to at their doctor’s office,” says Red Gillen, a San Francisco-based analyst with consulting firm Celent, who last month published a report on doctors seeking upfront payment from their patients. Gillen says that until recently, insurers paid so much of the cost of medical care that medical providers, including doctors, labs and hospitals, focused their fee recovery efforts on the companies. But in the past few years, Gillen says, employers and insurers have shifted more costs to consumers in the form of higher co-pays, higher co-insurance and higher deductibles, making those payments an increasingly large share of doctors’ incomes. According to Gillen, consumer out-of-pocket spending as a percentage of all health-care spending rose to 12 percent last year, and is expected to continue rising.

…

“Until now,” Gillen says, “insured patients would see a doctor, leave a co-pay and then watch a series of insurance and physician envelopes come through the mail over weeks to months, until finally one detailed the actual amount, if any, to be paid by the patient.” Now, largely through new software programs that assess both a patient’s insurance coverage and the day’s charges, those weeks to months are often collapsed into just minutes for an estimate, or even a full adjudication of the bill.

…

Increasingly, patients get a printout sometimes before but more likely after the medical visit detailing the full cost and the patient’s share, including any outstanding deductible. The estimate software has been created by some private firms, but also by a growing number of insurers including some Blue Cross plans, UnitedHealthcare and Humana. In April, Cigna, which has half a million beneficiaries in the Washington area, will be rolling out “The Estimator,” software that estimates a patient’s financial responsibility, usually by the time he or she has changed into street clothes. Cigna’s forms suggest that a doctor ask for no more than half of a patient’s estimated bill at the time of care, but every practice can set its own rules.

Read the Posts’s in-depth report on this issue, which includes patient and doctors’ office examples, as well as tips for consumers who may encounter fee-at-service payments, at their website.