The Importance of Patient Financial Policies Consulting

financial managementInsurance doesn’t always pay 100 percent of medical costs, which is why it puts patients in a position where they need to pay some of the expense out of their pocket. Other times, they have to pay all of the expense out of their own pocket due to a lack of insurance or lack of coverage for a specific type of treatment.

The way it typically works is the patient pays a co-pay, the insurance company is then billed, and the insurance company pays. If there is a deductible, then the insurance company may not pay until that deductible is met and then the patient has to pay the out-of-pocket expense outside of their co-pay that they already paid. Patients are responsible for their co-payments and any outstanding balances and requested payments are expected at the time of visits.

Reviewing Your Policies

It is good to have your patient financial policies reviewed by a healthcare consultant who can give you some tips on how to solidify your policy. Many practices lose money because of lax policies that are not strong enough in ensuring that patients pay the money that they owe.

It is also very important that patients understand that they could have to pay a balance that they may not necessarily expect. For instance, the insurance company could deny a claim and that leave the patient 100 percent responsible for their bills. Common reasons for insurance denials include:

•    The patient not meeting their policy deductible
•    A pre-existing medical condition that may not be covered
•    Insurance not in effect at the time treatment is sought
•    Coverage by more than one plan in which coordination of benefits has not been completed
•    Policy maximum has been reached
•    Medical services rendered are not covered by the policy
•    No referral for service if the policy requires a primary care physician to be listed

It is important to verify information with every patient and make any necessary changes to avoid any issues with receiving payment. Obtaining a copy of the drivers’ license and insurance card with every visit can help make this happen. That way there are no discrepancies in information when making claims.

Billing Procedure

There are different options that many physicians offer, such as self-pay. In this case, the services start at a discounted rate that is based on income, but can vary based on the severity of the injury or illness. If any procedures or tests are recommended, then the patient can be notified in advance so they can make an informed decision. This is a case where they will have to decide between what they can afford and what they can’t, as well as whether or not to continue treatment based on their financial situation.

Another option that physicians are frequently offering now is patient financing. This is where patients can finance their healthcare if they cannot pay for it all out of their pocket at once. Of course, credit qualifications must be met in order to qualify for financing in most cases. Nonetheless, this is a way in which procedures and tests can be paid for in an affordable way versus having to forego important tests and procedures for financial reasons.

Patient financing can be useful if there is a significant balance due after the insurance company’s payment. When that is the case, a statement is set to the patient’s billing address, notifying of balances due. Any balances that are not paid are the responsibility of the patient and payment in full expected upon receipt of the statement. Standard policies consider a payment to be past due if the payment is not made within 30 days and there is a late fee that is applied to the account each month it is past due. After 60 days, the account is sent to an attorney or a collection agency.

These are just examples of billing policies and how patient financial policies operate in some practices, as well as the different payment options that may be offered by physicians. It can be useful to have a healthcare consultant review existing policies and help you update them so that you can collect as much of the money due to you as possible.


If you need to have your patient financial policies reviewed and/or updated, MD Pro Solutions can help you. To learn more about our services, call us at 508-946-1665 or complete our contact form and someone from our office will contact you.