Get paid for procedures insurance won’t cover

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Getting paid for procedures continues to become more complicated. Many doctors are adding new procedures to their offerings that patients want and can benefit from, such as Botox to treat migraine headaches, dermal fillers for aesthetic purposes, laser therapies for scar reduction, stem cell and platelet rich plasma (PRP) injections for musculoskeletal disorders, genetic testing, and many more. But insurance companies often won’t pay for them. 

How can physicians collect on services not covered by third parties?

• Be transparent about cost. Before anything is done, inform the patient how much they will need to pay and why. If a service is one that needs to be done more than once, or has that potential, let the patient know first. The patient will be upset paying out-of-pocket only to learn that there will be further expenses in the future. 

• Ask the patient to sign a statement that they understand that they are responsible for the expenses. In my practice, if a patient receives a bill, they often claim they had no idea they were responsible for any payments. All we have to do is show them their signature and they cannot argue.

• Ask for payment up front.The simplest way to get paid is to ask for it before the service is provided. If a patient wants Botox, for example, they should pay for it prior to the injections. It is always harder to collect after the procedure is done. You can’t get that vial of Botox back even though you’ve already paid for it. That is just lost revenue. 

• Participate in care credit of other similar programs.Physicians can sign up for a program that allows patients to make payment plans rather than paying the whole amount at once. While this may not make sense for a procedure that is less costly, it may be the only way a patient can afford more expensive ones. This is often used by orthodontists when the cost for children’s braces is in the thousands of dollars. 

• Be clear about all treatment options.If there are alternative options available, share them with the patient and discuss the pros or cons of each. For example, a patient with a torn meniscus ma benefit from physical therapy and non-steroidal anti-inflammatories, which insurance will cover. However, some options not covered by insurance, such as PRP and stem cell injections, may have greater efficacy and be longer acting. When a patient is aware of everything that is available, they may opt for the therapy that they have to pay for themselves. If you don’t discuss all the alternatives, they may think you are just trying to sell them something. 

• Make sure your staff knows what is covered and what isn’t.A patient doesn’t want to schedule an appointment and be told the insurance will pay for it and then be disappointed. Also, the patient will get angry if they have the procedure done thinking it was a covered service only to get a bill later because someone made a mistake.

In our current healthcare system, we need to treat patients as decision makers, and the only way they can make informed choices is if they have all the facts. This does not only apply to the medical knowledge but cost factors as well.