Discussing Payment Options with Medicare Patients

You probably don't think it's “your place” to discuss secondary insurance plans with your patients. Think again. Do you know how many of your Medicare patients who don't have a secondary or supplemental insurance plan that covers that 20 percent co-insurance that Medicare does not pay? It probably costs you more than you think.

Pull up your list of Medicare patients that have a balance. Now look at those who have been sent multiple statements, yet have not sent in a payment. Are you going to send an 85-year-old patient to collections? Are you going to feel sorry for them and have your billing department adjust it off? You really ought to have a good idea how much this train of thought costs your practice on a yearly basis.

The next time you have a Medicare patient come in to see you, do a quick scan to see if they have secondary or supplemental insurance. If they don't, it's in your best interest to bring it up to them and let them know that it really doesn't cost them more to have it, than to not have it. Many seniors are on fixed incomes and claim they cannot afford another expense.

However, let's say Mr. Smith trips on his dog's favorite ball and falls. Mrs. Smith calls 911 and he lands in the hospital for a week following a broken hip and surgery. Then there's rehab after that which could go several months. If Mr. Smith opted out of paying for a secondary or supplemental insurance, that 20 percent could cost him thousands of dollars. Now, what's cheaper?

It's the gamble that many people on Medicare are willing to take, and it's costing you and your business a lot of money. Since Mr. Smith does not have a secondary, he is going to owe a lot of money. He is either going to pay it, or he is going to ignore it. By ignoring it, and at the age of 85, I'm sure he is not concerned about being sent to collection or ruining his credit. He is waiting for you to adjust it off. He is waiting for you to say, “I don't really need that 20 percent - let's be nice to Mr. Smith and just adjust it off.” You went into this line of work to help people, and he's a gambling man already by not having a secondary insurance, so he's going to roll the dice again and see if you will cave on his balance.

By talking to your patients at the time of their appointment, you are putting them on alert that you are not one of those physicians who will just “write it off.” Now, you have just taken the first step in holding Mr. Smith accountable for his account. If Mr. Smith insists that he will not be looking into a secondary or supplemental insurance, then you can share with him your payment policy for patients in his situation. This could range from paying $10 per month until his balance is satisfied, paying in full once he receives a statement, or breaking the balance into three easy payments.

I know it might feel awkward, and really not your place to be discussing this type of thing with your patients who are sick and elderly. But with the way reimbursements are declining, and physicians are closing their doors (or worse - going and working for the insurance companies!) either you take control of your A/R, or you will be walking down that same path.

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