# What are more healthcare facilities demanding payment up front



## debodun

My ophthalmologist started doing it and today I went to have a blood test that my gastroenterologist ordered and the lab asked for immediate payment. What gives?


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## Aneeda72

I don’t know, I never have to pay, I have double insurance.


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## Pepper

My guess, deb, is that they've been stiffed and also have slow payers.


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## jujube

When the lab knows that Medicare is absolutely not going to pay for the test, they'll usually ask you to pay up front.  It's a lot easier to get the money out of the patient  while he still wants the test than later when he regrets getting it.


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## Aunt Bea

It reduces the cost of sending a bill, processing the payment, etc...

On the flipside, my PCP didn't bother collecting the $10.00 copay on my last visit.  Probably too much hassle keeping cash on hand and sending someone to the bank every day.

I wish that they would raise the insurance premiums by enough to do away with copays and other annoying little charges.


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## win231

HAHA.  If you don't pay for a car, they can repossess it.
If you don't pay for a medical procedure, they can't take it back.
Besides, if you don't survive the procedure, they won't get paid.


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## MarciKS

Aunt Bea said:


> It reduces the cost of sending a bill, processing the payment, etc...
> 
> On the flipside, my PCP didn't bother collecting the $10.00 copay on my last visit.  Probably too much hassle keeping cash on hand and sending someone to the bank every day.
> 
> I wish that they would raise the insurance premiums by enough to do away with copays and other annoying little charges.


If they did could you afford the premiums? One nursing home here offers a $76 premium every 2 wks with next to no coverage & you get nothing till you meet the $6,000 out of pocket deductible.


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## Positivo998

win231 said:


> HAHA.  If you don't pay for a car, they can repossess it.
> If you don't pay for a medical procedure, they can't take it back.
> Besides, if you don't survive the procedure, they won't get paid.


Spot on


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## OneEyedDiva

Since COVID my eye specialist's office has given the opportunity to register (or update) online as well as provide a payment method. Before that, sometimes they'd take the payment before being seen, sometimes after.  The receptionists at my PCP's office have always taken the payment before seeing the doctor. I haven't been there since COVID so don't know how they do it now, but I have the option of choosing a free virtual visit.


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## Judycat

I was recently at my doc's for a checkup, and at the end, for the first time, they asked me to pay. Usually they wait until Medicare pays up then they bill me for the rest. Maybe it's my age and my chances of dying from the coronavirus. Better get that 20 bucks now or lose it forever.


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## MarciKS

is medicare still struggling to pay on time? if there's too much delay maybe that's why. but then doesn't that place more financial burden on you? or are you still paying what you normally would?


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## Don M.

Our Medicare Advantage plan (Humana) has waived co-pays and deductibles during this pandemic.   We've both had routine checkups at the doctor and hospital in the past couple of months, and didn't have to pay anything, up front.


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## Butterfly

I don't see what difference it makes to the patient whether they have to pay the copay up front or wait for a bill.  I'd prefer to pay it at time of service and get it out of the way.  To me, if there's a copay it's still the $20 or whatever up front, so whether I pay it now or next month doesn't make any difference to me.

It's easier and less of a hassle for the provider if they collect up front.


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## Aunt Bea

Yesterday I was laughing and cursing because I received a bill from the blood lab for $2.00 that wasn't covered under Medicare or my private insurance.

I hope that it cost them ten times more than it cost me to write a check and stick a stamp on the envelope. 

IMO a well-run business should set a _why bothe_r threshold to write-off small balances to save themselves the cost of collecting and processing those small balance payments. 

_"penny wise and pound foolish..." -_ Robert Burton, _The Anatomy of Melancholy_ 1621.


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## StarSong

debodun said:


> My ophthalmologist started doing it and today I went to have a blood test that my gastroenterologist ordered and the lab asked for immediate payment. What gives?


I nearly always have to make office visit and other standard copays up front.      

Why would it matter if you pay at the beginning or end of your visit?


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## hellomimi

StarSong said:


> I nearly always have to make office visit and other standard copays up front.
> 
> Why would it matter if you pay at the beginning or end of your visit?


I understand why it matters to deb when I read how she waited in line to redeem 60 cents for bottles. I see why it matters to her if money is coming out when she was used to not paying upfront in the past.


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## 911

StarSong said:


> I nearly always have to make office visit and other standard copays up front.
> 
> Why would it matter if you pay at the beginning or end of your visit?


If you have to pay for the test upfront, will Medicare reimburse? I have never been involved in any transaction like that, so I don’t know how that would work out. I would have thought that if the lab accepted Medicare, they would be satisfied with just submitting the claim, unless Deb has an Advantage plan, then it may be different.


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## StarSong

@911, I have an Advantage plan (Kaiser Permanente) and know what the copays will be.


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## 911

StarSong said:


> @911, I have an Advantage plan (Kaiser Permanente) and know what the copays will be.


I have no knowledge of Advantage plans, so I thought maybe her plan was not being accepted by the lab and maybe she would have to pay it and then wait for reimbursement.


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## debodun

I have traditional Medicare Parts A & B and well as a supplemental policy. I have never had to pay up front before at the same healthcare facilities.


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## Keesha

Butterfly said:


> I don't see what difference it makes to the patient whether they have to pay the copay up front or wait for a bill.


Maybe a cent in interest?


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## Butterfly

debodun said:


> I have traditional Medicare Parts A & B and well as a supplemental policy. I have never had to pay up front before at the same healthcare facilities.



Could it be a test that Medicare does not cover?  Are you talking about having to  pay the whole cost of the test, or just your copay?


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## debodun

Copay


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## StarSong

debodun said:


> Copay


If it was your copay, what's your objection?


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## debodun

I have two insurance plans. It seems everything would be covered.


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## Citygirl

*Deb: my eye Dr. always did want the copay up front but I have no copays for lab work. I'd like to know why you object to the before payment. It is going to be paid one way or the other before you exit that door anyway.*


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## Butterfly

debodun said:


> I have two insurance plans. It seems everything would be covered.



Not all drs' offices will bill your secondary insurance for you, so you might have to submit a claim and wait for reimbursement.  Also, here, there are some drs who have quit accepting certain secondary insurances because of payment issues so it is up to the patient to make a claim and get reimbursed.


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## Oris Borloff

One thing you may not be considering is that medical services are a business.  With all the covid protocols in place their customer pool is restricted, reducing the cash flow and overall revenue.  There are fixed operating costs to keeping the doors open even if half the staff has been furloughed due to reduced work load.  

It's not all covid either.  Sometimes, as happened in my state, after the previous governor cut medicaid payments and eliminated other state subsidized medical facilities, the small town hospital where my doctor is had to start getting up front co pays.  

Add insurers into the mix, that fight reimbursement, down right refuse reimbursement, government mandates, and don't forget many laws governing these things in states were actually authored by insurance companies.

It's not a simple answer.

The whole system in the US is basically a mess.  It was nearly 40  years ago when I worked in a hospital and I'm afraid it hasn't gotten any better.


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## Barbiegirl

So we are still on my husband's benefits plan, not Medicare, but for us it's customary to pay the co-pay on the day of the appointment. 

However, in-network providers often ask us to pay the rest of the bill up front and we always decline, because nine times out of ten once we get the insurance bill we see the provider has attempted to charge well above the contracted rate or even double bill. So we insist that we'll wait to get the invoice. That way the insurance company has had the chance to review it first and adjust fees to the correct amount.

If the provider is 100% out of network we often have to pay up front, though. That's why we try to stay in network as much as possible.


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## mathjak107

most doctors who want money up front because of deductibles   are in breech of their insurance agreements .

i once had a doctor i went to for the first time  demand i pay up front since my insurer  would not disclose how much of a deductible i had left ...

the insurer told them they wont tell them since i could have a claim already in house that meets my deductible .

so they forced me to pay 240 bucks up front ...

when i called my insurer they said he could be dropped for doing that ...their  agreement is the insureds are not to be charged against any deductible until after the claim is processed


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## debodun

The oral surgeon that is doing my implant doesn't accept any insurance, not that it matters to me since I don't have DI, but he did ask for $4800 before he even started.


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## Liberty

I lost over 4 grand several years ago due to a failed implant.  No guarantees on that!  No more for me, that's a fact...lol.


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## Aunt Bea

debodun said:


> The oral surgeon that is doing my implant doesn't accept any insurance, not that it matters to me since I don't have DI, but he did ask for $4800 before he even started.


Deb,

I have to say that did amaze me when I saw your post about handing over almost five thousand dollars to a dentist that you've only met once.

I'm not sure I understand how you could do that when you are usually so careful about getting several estimates and opinions before starting various home repair projects.

Good luck with your new tooth!


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## Don M.

debodun said:


> The oral surgeon that is doing my implant doesn't accept any insurance, not that it matters to me since I don't have DI, but he did ask for $4800 before he even started.



If you decide to go with another implant, check out Aspen Dental before you spend $4800.,  Their prices are less than half that, and they probably have an office within reasonable distance of your place.  One of my son-in-laws mother has had several in the past couple of years, and she is quite pleased with the results.


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## debodun

Closest Aspen Dental is about 20 miles away. Too late though - already paid for implant.


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## debodun

Another thing I've noticed on my last 3 doctor visits - they are not giving appointments at the patient's convenience. When I have to make a follow up - they say when to come in next. I countered with another time, but the clerk just reiterates the first date. What going on with that?


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## Don M.

debodun said:


> Another thing I've noticed on my last 3 doctor visits - they are not giving appointments at the patient's convenience. When I have to make a follow up - they say when to come in next. I countered with another time, but the clerk just reiterates the first date. What going on with that?



That seems to be the norm...with this ongoing Corona Virus.  Doctors, and dentists are seeing fewer patients, and limiting the numbers that might be in a waiting room, etc.  Many of them have lost some of their staff....who have quit because of this virus, and the potential for exposure.   Just add this to the increasing list of "inconveniences" we have to face while this illness is running rampant.


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## mathjak107

Liberty said:


> I lost over 4 grand several years ago due to a failed implant.  No guarantees on that!  No more for me, that's a fact...lol.


i had 4 out of 6 fail i did 10 years ago . i just replaced them this year with a new style .... 25k first time and 15k 2nd time


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## Pauline1954

Aunt Bea said:


> It reduces the cost of sending a bill, processing the payment, etc...
> 
> On the flipside, my PCP didn't bother collecting the $10.00 copay on my last visit.  Probably too much hassle keeping cash on hand and sending someone to the bank every day.
> 
> I wish that they would raise the insurance premiums by enough to do away with copays and other annoying little charges.




I kept paying my copay. Now I find out Ive got money in my doctors account. Ugh i met my deductible but kept paying and did not realize it.


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## needshave

I understand the concern with paying money upfront for services, I guess it did not bother me too much until a recent event. My father in law was placed in long term care (hospice) at a care facility in his area. Covid played a devastating role for the family, because we were not allowed in until the final hours. But the issue for me was this. We were paying $6800.00 every three months  for his care in advance. So another payment was due June 01, for june, july and august. We payed on May 21 for the upcoming three months. He passed on June 22. By the end of June we had asked for a refund for time not spent in the facility due to this passing. By the first of july I knew there was a problem and repeated calls and letters got no response. I had to get a couple of state and then federal agencies involved and still did not get a refund until October 01. Without interest of course, but we finally did get a refund. That is a sad reflection of the service and attitudes we expected. Sorry I had to vent!


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