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Collecting Deductible Resets and Patient Payments

10 million consumers were in high deductible health plans (HDHPs) in 2010. Less than ten years later, 75 million are enrolled in these plans, a 650% increase. For you, this poses a challenge because patients usually ending up paying more out of their pocket for your services. 

Deductible Resets

Deductible changes challenge patients and providers. Patients because they might not understand why their deductible went from $3,000 to $5,000 in one year or realize they also have a separate out-of-network deductible. When patients are frustrated and confused, they are less likely to pay you. Also, because of the increase, they might be unprepared and unable to pay when they receive their bill.

This causes a strain in patient-provider relationships and means cash flow and collection issues for you.

Consider these three actions to help ensure the efficient collection of payments:

  • Clearly Communicate Patient Responsibilities: A recent study revealed that 92% of consumers want to know their payment before a provider visit. Providers can offer patients an estimate of the amount of the bill prior to treatment. This is also a good time to explain all the payment options your office offers.
  • Make It Easy to Pay: Offering multiple payment channels is the best way to do this. Options could include cash, credit-debit cards, automated payments, and online or over the phone payments. Options increase the chances of getting bills paid and satisfy patients by allowing them to pay via the method they prefer. When patients can pay in the way that best suits them, it makes them more likely to pay. Contact your merchant processor to determine if they can also streamline alternate online payment methods such as PayPal, Google Wallet, MobilePay, etc.  
  • Automate Payments: By securing a payment method, providers can help patients pay down balances with less staff intervention. Providers should communicate expectations and set up automated payment plan policies that include minimum payments and the end date. The automated payment can also be leveraged to collect smaller claims balances. This offers convenience for the patients and guaranteed payment for the provider. Automatic payment plans (and payment plans in general) must be monitored for declined and missed payments.  

Success Stories


Average bill age when our office received: 180 days plus BALANCE: $ 1,233.00 PROBLEM: Claim denied needing primary EOB. SOLUTION: Claim billed to supplemental policy instead of MMAI policy which was effective for service date.
Average bill age when our office received: 180 days plus BALANCE: $ 2,176.00 PROBLEM: Claim denied because of no insurance coverage for service date. SOLUTION: Claim was filed to incorrect claims address.
Average bill age when our office received: 180 days plus BALANCE: $ 1,013.50 PROBLEM: Claim denied because of insurance ID mismatch. SOLUTION: Claim filed to traditional plan vs. community care.
Average bill age when our office received: 180 days plus BALANCE: $ 1,203.00 PROBLEM: Patient disputed charge/balance owed, comparing it to a similar past bill. SOLUTION: Explained itemized charges and balance owed because of deductible. Patient stated first time someone took the time to explain and set up a payment plan.
Average bill age when our office received: 180 days plus BALANCE: $ 1,007.50 PROBLEM: Denied by hospice as non-eligible benefit and Medicare as ID name mismatch. SOLUTION: Verified/corrected Medicare ID, name and date; confirmed hospice non-eligibility.
Average bill age when our office received: 180 days plus BALANCE: $ 1,305.00 PROBLEM: Denied no pre-authorization for service. SOLUTION: 3-way call with patient and insurance. No ER report on file when claim originally submitted. ER report since received.
Average bill age when our office received: 180 days plus BALANCE: $ 1,001.50 PROBLEM: Denied with "misrouted" and "claim not covered by payor". SOLUTION: 3-way call with patient and insurance. Claim was related to mental health so should have been filed through carve out policy.
Average bill age when our office received: 180 days plus BALANCE: $ 1,755.00 PROBLEM: No response from insurance after requested records submitted. Patient stated insurance paid. SOLUTION: Billing office did not receive/post insurance payment. Called insurance and records received but claims representative had not released for processing.
Average bill age when our office received: 180 days plus BALANCE: $ 4,540.50 PROBLEM: Multiple bills, same service dates as claims already paid. Denied due to no pre-authorization for service. SOLUTION: Call to insurance who verified no pre-authorization requirement. Two claims not found. To prevent duplicate denial upon resubmission, account rep notated resubmission for return transportation trip. Proof of timely filing submitted with claims.
Average bill age when our office received: 180 days plus BALANCE: $ 1,180.00 PROBLEM: Denied due to no pre-authorization for service. SOLUTION: 3-way call with patient and insurance. Claim should have been sent directly to IPA vs. umbrella insurance location.
Average bill age when our office received: 180 days plus BALANCE: $ 1,117.00 PROBLEM: Unpaid due to incomplete demographic information. SOLUTION: Contacted pick up and drop off locations. Sent release to obtain information and patient’s name misspelled.
Average bill age when our office received: 180 days plus BALANCE: $ 1,605.00 PROBLEM: Denied due to medical necessity. SOLUTION: 3-way call with patient and insurance. Spoke with multiple reps and received different answers including claim not found. Claim was found with no response from medical board. Patient had to submit medical records.
Average bill age when our office received: 180 days plus BALANCE: $ 1,007.50 PROBLEM: Denied multiple times as duplicate. SOLUTION: Located claim number ID, amount paid and date paid. Claim had already been paid in full but not posted.
Average bill age when our office received: 180 days plus BALANCE: $ 1,650.00 PROBLEM: No insurance on file. SOLUTION: Pick up location was state prison. Located inmate ID and could be billed to prison insurance as still within timely filing limits.
Average bill age when our office received: 180 days plus BALANCE: $ 2,295.50 PROBLEM: Denied as “forwarded to another entity for processing”. SOLUTION: Called insurance for medical group processing information. They did not have claim on file. Resubmitted with proof of timely filing.

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RMK Holdings Inc.

111 North Avenue
First Floor, Suite 104
Barrington, IL  60010

866-446-4800 toll-free phone

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