Don’t Let High Deductibles and Co-Pays Create Chaos in Your Practice

Don’t Let High Deductibles and Co-Pays Create Chaos in Your Practice

More and more providers are feeling the effects of high deductibles in health plans when it comes to reimbursement and patient collections. Although the Affordable Care Act has lowered uninsured rates in the U.S. from 15.7% in 2009 to 9.1% in 2015[1], the number of patients delaying needed healthcare continues to rise as more of the cost-sharing has shifted from government and third-party payers back to the patient.

The Deductible Creep

As deductibles continue to creep upwards at a faster rate than workers’ wages, and as the number of patients enrolled in high-deductible plans increases, a greater number of insured patients have reported difficulty paying medical bills. With the average fees totaling $300-$500 for an initial patient visit, it is no surprise that some practices may be seeing fewer new patients, and fewer of them are making a commitment to care. Patients are looking for access to affordable care in your office, but before offering a “cash” discount, remember that offering deals to patients outside of a contractual discount (PPO, MCO, DMPO) can put your practice at substantial risk of fines and penalties if the discounts are offered improperly.

The best way to keep patients happy, improve clinical outcomes, and enhance collections in your practice is to clearly and openly discuss your fees and payment policy upfront. By conducting a formal Financial Report of Findings in your office, you can clearly outline your treatment plan and the patient’s estimated out-of-pocket expense. Now, more than ever, we need to educate our patients on what their insurance will pay and what is their own financial responsibility.

Compliance is Key

When it comes to discounting your fees, compliance is key. Discount Medical Plan Organizations are a great way to offer patients with high deductibles the benefit of a lower fee than they might have when using their insurance. Providers who offer these types of memberships to their patients give their patients the same types of discounts that insurance carriers have negotiated for those same services.  Many times, the discounts to patients are the same, or lower than the co-pays or high deductibles they are accustomed to paying for their treatment with robust insurance plans. Having a contractual network agreement with a DMPO is what makes the discounts you offer legal and compliant.

If you are a network provider, you know that your provider agreements require you to file claims with the insurance carrier. We want to be a good corporate citizen and encourage you to honor those agreements. But we also have an obligation to let patients know what their payment options are. Thanks to HIPAA/HITECH regulations, you now have the ability to have patients opt out of filing claims with their health insurance. One of the caveats is they must pay you in full.

Offer Payment Options

We also need to offer affordable payment options, while still maintaining a compliant practice. One of the simplest ways to do this is by offering automated payments.  This is a great tool to ensure that your patients complete their recommended care, reduce missed visits, and eliminate the sting of out-of-pocket payments at the end of each visit. In fact, orthodontists have successfully used this technique for years.

Initiating a solid plan for helping your patients with high deductibles and co-pays today will set you up for success at the start of the new year. To learn more about utilizing these tools in your practice, visit https://www.chirohealthusa.com/resources/conversation-guide-videos/

About the Author

Dr. Ray Foxworth is a certified Medical Compliance Spe­cialist and President of ChiroHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation, and compliance. He has served as president of the Mis­sissippi Chiropractic Association, former Staff Chiro­practor at the G.V. Sonny Montgomery VA Medical Center and is a Fellow of the International College of Chiropractic. You can contact Dr. Foxworth at 1-888-719-9990, info@chirohealthusa.com or visit the ChiroHealthUSA website at www.chirohealthusa.comJoin us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind. Go to www.chirohealthusa.com to register today.


[1] https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201605.pdf

About Author

Ray Foxworth, DC, FICC, MCS-P

Dr. Ray Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. He has served as president of the Mississippi Chiropractic Association, former Staff Chiropractor at the G.V. Sonny Montgomery VA Medical Center and is a Fellow of the International College of Chiropractic. You can contact Dr. Foxworth at 1-888-719-9990, info@chirohealthusa.com or visit the ChiroHealthUSA website at www.chirohealthusa.com. Join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind.

Go to www.chirohealthusa.com to register today.

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