Deductible

The amount a patient must pay out of pocket for covered healthcare services before the insurance plan begins to reimburse. Deductibles reset annually and vary by plan type.

A deductible is the amount a patient must pay out of pocket for covered healthcare services before their insurance starts paying. If a patient has a $2,000 deductible, they pay the first $2,000 of covered services themselves, and then the insurance kicks in. Deductibles reset annually, usually on January 1. This is why many practices see a spike in patient payment collections in the first quarter of the year. Patients who have not met their deductible will owe you their full allowed amount for services rendered, rather than just a copay. As a provider, you are responsible for collecting the patient's deductible amount. This is specified in your payer contract. You cannot waive the deductible as a courtesy to the patient, because doing so can be considered a violation of your participation agreement and potentially fraud. Verifying a patient's deductible status before their visit helps avoid surprise bills and collection issues. Check their eligibility and benefits through the payer's portal or clearinghouse before the appointment. If they have a $5,000 deductible and have only met $500 of it, you know to collect a significant portion at the time of service. High-deductible health plans have become increasingly common, especially those paired with Health Savings Accounts. These plans have deductibles of $1,500 to $7,000 or more. If you see a lot of patients with HDHPs, having a clear financial policy and collecting at the time of service is critical for your practice's cash flow.