Whats legal and not legal when collection deductibles? For example, if someone has a $1000 deductible and is having a procedure done that only cost $275, is it legal for the facility to collect the entire $1000 deductible at time of treatment?
perhaps I'm not clear on your question, Pyper?
If someone has a $1000 deductible, and undergoes services/procedures which come to $275, then they have "met $275 of the $1000 deductible", leaving the Clt/Pt out-of-pocket for that $275. Before their 80/20 or 70/30 copays kick in, they will be out-of-pocket for future services to the tune of the add'l $750 left of their deductible to meet. They must have incurred services coming to the total amount of their deductible (in your example, the $1000) prior to the insurance kicking in so that they only have a co-pay amount they will owe.
Does this sound like I've understood your question?
I could only guess that to be an 'illegal' practice (given I'm not a lawyer) - it would most certainly NOT be professional or ethical practice in which to engage. And I certainly would NOT go back to a place that would do that. They only have the 'right' to the amount of the services rendered, NOT the entire amount of the deductible that is so far OVER that services-rendered-amount!
in reference to the aspect of this being legal, if the practice particpates w/the insurance co that the patient has provided, per their contract w/the insurance co the practice is only allowed to bill the patient for the amount stated on the EOB after they have billed the patient's insurance and not before than. If they were to try and collect more than that they would be committing fraud and out of compliance with their contract that they have signed and stated they would abide by. This would totally be illegal and could be reported to the insurnace commissioner!!!! Not a good practice to get into as once you do that, the practice would get a reputation for commintting fraud and would not be offered contracts with any insurance company.....beside just where would you post the monies to on the patients account if the EOB stated you should only be collecting the amount stated per the patients deductible, it would sit on you A/R as an outstanding balance owed to the patient and there are laws againist keeping patients monies that show up as overpayments on their account!!!
It also wouldn't make any sense because you have no idea if the patient will go to other clinics to satisfy the deductible, of if the patient is filling prescriptions that the deductible applies to at a pharmacy. A provider is entitled to the contractually agreed amount for services rendered, nothing more and nothing for services that may or may not happen in the future. The patient could die tomorrow for all anyone knows.
The wording of the question is confusing. Facilities (hospital, outpatient surgical center, etc) will often collect the deductible to cover the associated facility fees and charges. The office of the physician performing the service will usually only collect the allowable amount for the procedure itself.