CA doctors offices mandating payment upfront for services- is this legal? Why is this common practice? (health insurance, loans)

[UserName14289]

Originally Posted by sunshinelove0000

I have only been living in CA for a few months, however I have noticed that nearly every doctors office I've been to (and I am establishing care out here with new specialists, so I've seen a lot) makes their patient pay before medical services are rendered. This is something I am not used to (I'm from MA). It hasn't been a problem because after the first time I asked the front desk to bill me for my co-pay and was told I could leave if I didn't pay upfront, I learned to just make sure I pay right then and there.

Is there a huge issue in CA with doctors not getting paid or something? I have been seeing doctors in SF, down near LA, in SB, in SLO.. pretty much all over.. and it's the same at every doctor's offfice. I could understand demanding payment upfront if you had no proof of insurance, but I bring my insurance ID card to each appointment and a picture ID to verify that it's really me.

I was shocked when I went for lab work and they wanted me to pay $500 upfront! I was like wtf- NO, I don't have that kind of money. They said that was my estimated costs. I asked them what that was based on? What they bill my insurance or the contracted rate? They said what they bill my insurance... so I told them to call my insurance and find out what the contracted rate is, and that I will pay my portion of the contracted rate. Sure enough, after the girl at the front desk begrudgingly called my insurance, my portion of the costs of the blood work was only $14!!! And that was because the contracted rate is far, far less than what they bill the insurance company.... But back home in MA I never once had to pay for lab work upfront (because what they charge/bill insurance is always way more than the contracted rate so it is easier to send me a bill than have me fork over a ridiculous amount of money and then have to wait for a refund when my insurance comes back to say that it is a lower amount).

Anyways, just wondering if this is a CA thing that I havent been able to get used to.. or if it is even legal? If this is just how it is here in CA, does anyone know why? I know about Emergency Medical Treatment & Labor Act (EMTALA) but I have even seen signs saying "copayment due before services rendered" in an urgent care facility... so that threw me off... I didn't think doctors could turn you away for things like urgent care (not necessarily "emergency" care but still considered urgent/necessary) or lab work for not being able to pay.

Is this unique to CA? Is there a reason why CA doctors seem to have such strict policies when it comes to paying before you're seen?


side note: completely unrelated but I love seeing doctors in SB and LA.. their offices are often decorated so beautifully that you forget you're in an exam room. Nothing cold and "sterile" there!

IMO, medical care in SoCal is atrocious. I'd list all the ways, but I'd be here too long. What you're experiencing is a result of that.

[dexter75]

You can thank Obama and the Democrats for that. Fools in CA keep voting Democrat, the true definition of insanity.

[FireFly2]

Physicians in my state always ask for my copay before I am seen. My dentist requires my copay before I leave. I've actually never heard of a physician not asking for the copay upfront. It's strange that it would be state dependent.

[MItoBH]

Originally Posted by sunshinelove0000

I have only been living in CA for a few months, however I have noticed that nearly every doctors office I've been to (and I am establishing care out here with new specialists, so I've seen a lot) makes their patient pay before medical services are rendered. This is something I am not used to (I'm from MA). It hasn't been a problem because after the first time I asked the front desk to bill me for my co-pay and was told I could leave if I didn't pay upfront, I learned to just make sure I pay right then and there.

OP, this is an interesting post, so thanks for sharing your experience. As I'm currently in Michigan, and planning my move to SoCal about 11 months from now, I'm getting a lot of medical stuff taken care of while I'm still in Michigan, so that I won't be in a rush to see a doctor immediately upon my arrival in CA. Here in Michigan, we pay after the visit. If there is something insurance doesn't cover, I'm billed for it, and pay it. It's been my experience as someone who lives in the mid-west, that when we move to the coastal states, things are just different and there are more obstacles to jump over. I experienced a huge lack of TRUST in the consumer and the public at large; more security steps are in place, more paper, less efficient. When I opened a bank account in Maryland, the process was more scrutinizing. When I insured my car through State Farm in New Jersey, they took pictures of my car, needed my license, and asked personal questions. This was around 1997-2001, but still, the processes of things I took for granted of in mid-size city fly over country is more rigid in large metropolitan areas. But I digress...

In regards to the demand of payment BEFORE you see your doctor, thankfully you've had the money. But there may be a time you don't have the extra $300+. When I had to get two crowns last month at the dentist, it was going to be a little tough coughing up the $900 I had to pay out of pocket, so the receptionist told me about Care Credit, it's a credit card through Synchrony Bank (never heard of them) that is for HEALTH care only. And the best thing about it is that it's interest free - however, if you miss a payment, the interest goes from 0 to 26%. I used it for my dental bill and I'll pay if off in like 4-5 payments. It's a good peace of mind, especially as I head to CA.

[gemstone1]

“Proliferation of high deductible plans, deadbeats that don't pay their bills and Obamacare”.

“You can blame Obama and the Democrats for that."

....let’s not miss an opportunity to blame the Affordable Care Act....lets blame it for the melting ice cap as well. Regardless of me presenting my valid insurance card, I had to pay up front 20 years ago in Indiana...was that the fault of the ACA ?...Or the Republican leadership ? No, it was a lazy a$$, dollar oriented doctor and staff….needless to say I opted for a different Dr. the next time.

“You cannot be denied treatment in an emergency (emergency room)”....yes you can. If the issue is not an emergency, you can be denied care in a private hospital.

[Ruth4Truth]

Originally Posted by BuildingsR' Us

"I asked the front desk to bill me for my co-pay and was told I could leave if I didn't pay upfront, I learned to just make sure I pay right then and there."

What kinda of tone did she give off? Threating? GTFO?, Ignorant? Or the kinda of attitude like "Time is money, and if you cant pay, then we can't afford to waste the time of our busy, strict scheduled doctors." ?

Bill you for your copay? I'm not sure what you're talking about in your OP. Co-pays normally are due at the time of arrival for the appointment, and that's common all over the US. I don't see that as a problem. I have a lot of family members in CA, and none of them has had to pay for the entire service upfront, either. What kind of insurance do you have? Some providers refuse certain types of insurance. Not sure what's going on, here. Maybe you've had a run of bad luck, trying out the wrong doctors?

[Curmudgeon]

A lot of this could go back to the common perception in the 40s and 50s that doctors were always the last to get paid. People seemed to think that because they were "rich" doctors and healers that they wouldn't mind waiting. Now, it's big business and rather unforgiving. Brave new world!

[expatCA]

I am used to a copay.

What I am unhappy with is my accountant just told me my company may have to pay a penalty for .... paying 100% of our employees health care through a Medical Insurance plan with UHC, but not the "public" plan. Penalized for paying for a better plan for our employees??????

[ForeverSarah]

Sunshine,
Welcome to California :-\
It's important to understand your policy. Copays are usually required upfront, and offices can demand them before rendering services (except emergency services). Coinsurance is a percentage you pay based on the providers contracting status with your insurance company. Deductible refers to the amount you're responsible for before your insurance kicks in. Here's where it gets tricky. Only the copay can be demanded upfront in most cases. The deductible and coinsurance amounts are subject to your police's payment arrangement, and must be calculated through the claims process in order for the correct amout to be billed to the patient. Often people end up paying providers more than they should. Save your EOB's, or 'explanation of benefits,' a document your insurance company sends you for the claims billed in your name.
Read up on your policy, learn how to maximize and use it. Otherwise you'll likely pay :-\

[NoMoreSnowForMe]

I've lived in CA, WA and TN, and I'm pushing 60 years old. I have always been asked to pay my co-pay when I checked in at a doctor's or dentist's office. I do recall having to wait while they contacted my insurance regarding my coverage and my co-pay. I've never been asked to pay some weird inflated estimate.