At the present time, hospitals and many surgeons and other providers review your health insurance benefits, specifically deductibles and co-insurance, before they see you for care. Part of what they look at is; how close is the patient to meeting their deductible and would they owe a lot of money for care? Why do they do this? All businesses want to be paid for the services and goods they provide. Healthcare providers know their charges for services and what they expect to be paid by the insurance companies. To that end many will collect amounts they know will be owed to them ahead of time or at the time care is being provided opting to skip the more expensive route of just billing after care is provided.
Unlike when you go to the doctor’s office and pay a co-payment if you are on a PPO non H.S.A. based plan, for other care cost typically will vary and are not a set dollar amount per visit. The providers know what they will get paid usually and generally also know what services will be provided. That is how they determine what your deposit should be. When at the doctor’s office where a co-payment is due that is a fixed amount based on the plan’s benefits so the co-payment is handled a bit differently because it is a set fee paid not a deposit.
When you have a large deductible that is not yet met, the providers want to ensure they don’t provide you with either uncompensated care or provide you with a free loan. In order to protect from these situations they require, and the insurance carriers typically allow, a deposit against the cost of the care. The deposit should be no more than you would owe based on how much of your deposit is already met. You should not be asked to fund the full procedure with refunds coming after insurance processing of the claim, unless that amount is less than what you still owe on your deductible.
Should you know ahead you have a large deductible and it can’t be paid all at once, it’s typically wise to speak to the provider ahead of time to see what kind of payment plan can be arranged. Often hospitals will take a down-payment and set up a payment plan where the deductible and co-insurance can be paid out over the course of a few months. Don’t expect long term financing of these amounts, but a three to six month window depending on the amount is a possibility.
You should always know how much you still owe towards your annual out of pocket maximum. Keep in mind with most plans co-payments do not count towards these maximums, they only capture deductible and co-insurance. It should be easy for you to track and needs to be tracked to make sure your and the insurance carrier numbers match. Remember in-network and out-of-network maximum out of pocket costs add up in different buckets, so often if you use services in one of the other it does not necessarily fill both buckets.
If you are going to the hospital for elective surgery, scheduled well ahead of time, you will almost always spend some time at the hospital ahead to conduct pre-operative reviews. These reviews are medical and financial. At this time the hospital staff will conduct a check of benefits and see where you are with regard to meeting the maximum out of pocket. They will then discuss with you the expected cost of care and where your personal costs are expected to be. At that time they will ask you to pay a deposit for your expected out of pocket costs. This is a good opportunity to seek more information about a payment plan if paying in full your liability is not possible. (Often a payment plan with the hospital is preferable to putting it on a credit card at a high interest rate, so do ask.)
Healthcare is expensive to obtain and for most providers to provide. To that end the providers are just ensuring they are going to get paid for their services and goods provided. That is why you are asked to pay a deposit for care in many cases. Before thinking the providers are unfair with collecting what is owed to them, ask yourself would you want your employer to pay you only when they feel like it despite your working your 40 hours every week?
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