How to Treat Uninsured Patients

As of January 2010, medical insurance is not a mandatory requirement in the United States. The occasion might arise when a patient with no insurance coverage (whether due to financial reasons, job loss or the inability to self-insure due to pre-existing conditions) comes to your office for treatment. Care must be provided in a timely manner, regardless if they have insurance or not, so a protocol should be in place with your billing and reception staff when it happens.

Instructions

• 1

  Initiate interim coverage if the patient meets criteria. While some patients might have elected not to be covered by their employer, some might not have coverage due to a job loss or monetary reasons. If you are a contracted provider through your state's Medicaid program, ask the patient if they might qualify for state aid and explain that if they are eligible, they can have the services covered or pay a share of the cost. Requirements for Medicaid vary from state to state. For example, in California, someone collecting food stamps, a dependent under 21 or the blind qualify for Medi-Cal whereas in Alabama, pregnant women who fall under the poverty level also qualify for coverage. If a newborn needs treatment, they will most likely be covered under the mother's ID for the first month. The State Children's Health Insurance Program (SCHIP), instituted on April 1, 2009, offers coverage to dependents whose eligibility is determined by criteria mandated by the state. Coverage will vary depending on which state where you're located.

• 2

  Determine procedure codes that can be billed to the patient. CPT (Current Procedure Terminology) codes indicate a service or procedure for which the doctor can bill. Contracted rates negotiated with insurance companies often include procedure or consult codes that could be waived in the case of a private-pay account. For example, if you are setting up the patient with medical equipment in the home and would normally charge the insurance company a fee for set-up, instruction and consult (99243) along with the equipment rental code (E1392), you might waive that and instead simply charge the patient the private-pay amount for the concentrator monthly rental ($150).

• 3

  Consider what amount you can charge and still make a profit then use that as the basis for your private-pay fee. A doctor knows the lowest amount he can charge for an office visit. However, if you are providing supplies or services such as radiology, you will need to determine what that treatment is worth. If you are a pediatric clinic with a high percentage of asthma patients, consider stocking home care treatments for the patient, such as a nebulizer or peak-flow meter, that will obviate repeated trips to the office. Putting the patient or his caregivers in charge of their own care will reduce costs to the patient in the long term.

• 4

  Negotiate any payment plans and put the installment dates and amounts in writing. If you're a dental provider doing porcelain veneers, have your billing department design a plan of treatment with all the costs spelled out so there is no misunderstanding for the services rendered. If possible, collect credit card information from the patient even if they are paying in installments by check. In the event there are problems collecting later payments, you will have recourse to charge the account.