Self pay (Insured shortfalls)

In order to control the costs of the premiums, insurance policies will have elements which are not covered by the policy. This will be due to benefit limits, patient excess on the policy or co-share policies, where the patient has to pay a percentage of each invoice. A major percentage of the insurance market is also corporate policies so employees who benefits from this at times do not know the small print in their policies until they come to use it. 

Depending on the specialty and type of practice, shortfalls in insurance payment are normally by far the largest volume of the self-pay invoices and the hardest to collect. 

This is because most patients do not understand their insurance policy, as touched on already, and they believe that all costs are going to be met by their insurer. 

So when they receive an invoice for their element of the treatment, it is an invoice they are not expecting. 

From our experience, a lot of them ignore invoices, as they are under the misapprehension it is a copy of what has been sent to the insurer. 

So unless you follow this up with a phone call, it will just be ignored. 

Once they are aware that the invoice is correct, then they may contest this with their insurer, as they believe all costs should be met under the terms of their policy. 

A large part of what we do on behalf of our clients is liaise between the insurer and the patient to ensure that it is clear who owes them the money. 

Once the patient accepts that the money is owed by them and depending upon the amount that they owe, you need to be in a position to either take payment immediately or agree terms. 

We can take payment by phone, online or even by cheque. When you also consider the time collecting shortfalls can take to be done properly, it might be worth considering leaving it to a company dedicated to this area of a practice. As we are paid on monies collected, more and more practices are seeing the commercial sense in entering in to such an arrangement.

Danielle Connor