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Doctors, hospitals and medical labs used to be concerned about patients who didn't have insurance not paying their bills. Now they're scrambling to get paid by the ones who do have insurance.
For more than a decade, insurers and employers have been shifting the cost of care onto their workers and customers, tamping down premiums by raising patients' out-of-pocket costs. Last year, almost half of privately insured Americans under age 65 had annual deductibles ranging from $1,300 to as high as $6,550, government data show.
Now, instead of getting paid by insurance companies on a predictable schedule, health care providers have to engage in an awkward dance. One moment they're removing a pre-cancerous skin mole. The next, they're haranguing patients to pay what's become a growing portion of the total medical bill.
"It's harder to collect from the patient than it is from the insurance," said Amy Derick, a doctor who heads a dermatology practice outside Chicago. "If the plans change to a higher deductible, it's harder to get the patients to pay."
Independent physicians cited reimbursement pressures as their biggest concern for staying in business, according to a report by Accenture PLC in 2015.
"If they have to decide if they're going to pay their rent or the rest of our bill, they're definitely paying their rent," said Gerald "Ray" Callas, president of the Texas Society of Anesthesiologists, whose Beaumont, Texas, practice treats about 40,000 people annually. "We try to work with the patient, but on the other hand, we can't do it for free because we still maintain a small business."
In 2016, Callas introduced payment options that allow patients with expensive plans to pay a portion of the bill upfront or on a monthly basis over several years. Even so, Callas said the number of people avoiding his calls after surgery has increased "tremendously" each year since the Affordable Care Act passed in 2010.
Derick instituted a "time-out" option a few years back that gives patients the billing codes before a procedure, allowing them to call their insurance companies for estimates. Even with the program, collection rates are slower, especially at the beginning of the year when insurance plan deductibles reset.
Even large medical companies with national operations are facing the problem. Quest Diagnostics Inc., the lab-testing giant, said 20% of services billed to patients in the third quarter of this year went unpaid, costing the company about $80 million in lost revenue.
"We certainly have a high bad-debt rate for the uninsured," Chief Financial Officer Mark Guinan said in a telephone interview. "But really the biggest driver is people with insurance. It's their coinsurance and their high deductibles, and they don't always pay their bills."
(Related: Health Reform Is Really Hard: S&P Panelists)
