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Old 11-23-2015, 02:43 AM
 
797 posts, read 1,734,915 times
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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!
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Old 11-23-2015, 06:26 AM
 
25,619 posts, read 36,505,929 times
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Proliferation of high deductible plans, deadbeats that don't pay their bills and Obamacare. Welcome to the new normal.
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Old 11-23-2015, 10:23 AM
 
61 posts, read 79,570 times
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"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." ?
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Old 11-23-2015, 10:40 AM
 
797 posts, read 1,734,915 times
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Quote:
Originally Posted by Bulldogdad View Post
Proliferation of high deductible plans, deadbeats that don't pay their bills and Obamacare. Welcome to the new normal.
You know I honestly hadn't thought of this but since "romneycare" originated in MA, I do wonder if the fact that in MA they had to deal with something similar to "Obamacare" for many years now is why docs in MA seem to have worked out the kinks... It seems like (from my experiences this far) the registration/billing process is much more of an undertaking here than it was in MA...
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Old 11-23-2015, 10:46 AM
 
797 posts, read 1,734,915 times
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Quote:
Originally Posted by BuildingsR' Us View Post
"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." ?



well considering she didn't understand what I meant when I asked if the doctor had rights to the local hospital or if he was independently running his practice, I'm going to say "ignorant"... Like I said I would understand doctors not wanting to waste time on those who can't pay if they don't have insurance but I do have insurance and had proof of it
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Old 11-23-2015, 01:02 PM
 
Location: Carmichael, CA
2,410 posts, read 4,417,393 times
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I don't know how it played out in MA, but here most of the people that signed up for Obamacare went with the MediCal option (it was a really high percentage of applicants, don't recall exactly.)


MediCal has extremely low reimbursement rates to the doctor, so the only way doctors can counter the loss is to be absolutely sure they get every dime owed from the insurance customers.


My medical provider added a lot of new plans/options when Obamacare kicked in January 2014, and I remember sitting in the waiting room while the check-in person demanded co-pays up-front before anyone could even sit down to wait for their appointment.


But we're being assured that it's better this way, so I guess just make sure you have enough money when you go to the doctor.
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Old 11-23-2015, 01:27 PM
 
797 posts, read 1,734,915 times
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Originally Posted by cb73 View Post
I don't know how it played out in MA, but here most of the people that signed up for Obamacare went with the MediCal option (it was a really high percentage of applicants, don't recall exactly.)


MediCal has extremely low reimbursement rates to the doctor, so the only way doctors can counter the loss is to be absolutely sure they get every dime owed from the insurance customers.


My medical provider added a lot of new plans/options when Obamacare kicked in January 2014, and I remember sitting in the waiting room while the check-in person demanded co-pays up-front before anyone could even sit down to wait for their appointment.


But we're being assured that it's better this way, so I guess just make sure you have enough money when you go to the doctor.
Tbh I'm not sure how it played out in MA because for years it's been the "law" to have insurance. I know MassHealth (what I assume is the equivalent to MediCal) has been around for years and it sounds like it is similar to MediCal in the sense that the docs don't get reimbursed much. So that does make senses that docs here in CA want to ensure they get every penny they can if the plan doesn't reimburse well.

thanks for your input, that definitely paints a clearer picture.
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Old 11-23-2015, 01:34 PM
 
Location: SF Bay Area
12,287 posts, read 9,769,656 times
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It is cheaper to mandate payment up front.
Billing has an associated cost, let alone the people who don't pay to begin with.
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Old 11-23-2015, 02:36 PM
 
797 posts, read 1,734,915 times
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Quote:
Originally Posted by shooting4life View Post
It is cheaper to mandate payment up front.
Billing has an associated cost, let alone the people who don't pay to begin with.
True. I had never given that much thought. Like I said it was normally never a problem back in MA so this is new to me but I can now see why docs in CA do it
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Old 11-23-2015, 06:42 PM
 
442 posts, read 1,571,718 times
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It is not unique to CA. I'm in FL and worked for a very large, well established regional health system here and this was commonplace. You cannot be denied treatment in an emergency (emergency room), but urgent care, doctor's office, lab and any other type of facility are different.

Co-pays and a portion of your deductible are required up front (you're responsible for them for the year, anyway), anything beyond that can usually go through the insurance then billed to you later. This started taking place around the same time as Obamacare..not sure if it's rising costs for the facilities, insurance companies or Obamacare that has made healthcare centers more aggressive in taking payment.

I did notice our particular health system started expanding regionally and building fancier facilities too. Perhaps that's part of the reason they were aggressive in their taking of payments upfront, too
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