{"id":288,"date":"2017-05-10T14:21:42","date_gmt":"2017-05-10T14:21:42","guid":{"rendered":"https:\/\/dbmafl.com\/?p=288"},"modified":"2017-05-10T14:21:42","modified_gmt":"2017-05-10T14:21:42","slug":"large-deductibles-and-co-pay-tips","status":"publish","type":"post","link":"https:\/\/dbmafl.com\/?p=288","title":{"rendered":"Large Deductibles and Co Pay Tips"},"content":{"rendered":"<p><strong>Large Deductibles can be resolved in a couple ways<\/strong><\/p>\n<p>In\u00a0our business\u00a0we get asked how to deal with a client that has a large deductible.\u00a0 Our responses are listed below.<\/p>\n<ul>\n<li>Client can waive usage of their insurance<\/li>\n<li>The provider may charge the client and expect to be paid the allowable or some portion of that until the deductible is satisfied.<\/li>\n<li>If\u00a0under contract with the insurance company it\u00a0states that you may not charge the client more than the allowable not that you have to collect it.<\/li>\n<li>If\u00a0in a group the client can be assigned\u00a0to a non contracted provider with that insurance.\u00a0 Then the client\u00a0may be\u00a0put on a \u00a0sliding fee.<\/li>\n<li>If out of network with the insurance the client may be charged the standard fee and the client may go elsewhere or decide to pay\u00a0for that service in full.<\/li>\n<\/ul>\n<p><strong>Co Pays<\/strong><\/p>\n<p>With a lot of non profit agencies they struggle with how to work with co pays when the client states that they cannot afford to pay 60.00 per session.\u00a0\u00a0If\u00a0this is an in network provider than\u00a0the contract says the\u00a0client must be \u00a0charged the\u00a0co pay.\u00a0 It does not say\u00a0that the client must pay the co pay.\u00a0\u00a0 So keeping this in mind what\u00a0we often advise our groups is that which is stated above.\u00a0 The <strong>client\u00a0must be charged<\/strong> the co pay, a negotiation may be made with the client\u00a0to accept a lesser fee and write off the difference.\u00a0 The client ledger must show the 60.00 charge but it is not necessary to show a payment of 60.00.<\/p>\n<p><strong>Words of Caution<\/strong><\/p>\n<p>Always keep in mind that often the allowable for a service may only be 60 or 65 so that co pay may be the only reimbursement.\u00a0\u00a0 There are a number of Aetna policies out there with a 70.00 co pay.\u00a0 Master&#8217;s level providers allowable is almost always less than that.\u00a0 So the best bet may in some cases be not to use the insurance but to negotiate with the client for\u00a0a reasonable fee.\u00a0\u00a0 Be mindful of the allowable whether\u00a0 in network or out of network when co pays or deductibles are involved to ensure that you get the reimbursement you deserve for the clients you serve.<\/p>\n<p>**Medicare deductible is a different animal and it is only 183.00 for Part B.\u00a0 The advice is not to charge the client the deductible and wait for the explanation of benefits to come back before pursuing this with your client because they may have a secondary that picks it up.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Large Deductibles can be resolved in a couple ways In\u00a0our business\u00a0we get asked how to deal with a client that [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[4],"tags":[],"class_list":["post-288","post","type-post","status-publish","format-standard","hentry","category-billing"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v19.7.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Large Deductibles and Co Pay Tips - DB Management &amp; 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