No, I have not heard of this. I did, however, get told by our hospital when I was scheduled for thyroid surgery in December, that if I had a deductible, I would have to pay it upfront. First I had heard of that, also.

No but one dr requires i pay my entire ded. on day of visit. Also my colonoscopy guy required a deposit but it wasn't much, maybe 25% of my ded.?

Contact your insurance company. Physicians that choose to accept certain insurance plans agree to conduct business and charge the patient per the contract. Your insurer will know if your podiatrist is operating within contract by requiring a 10% cash deposit up front.

I haven't heard of that, yet. I appears like a really big co-pay up front, and maybe excessive. Here's why: The clinic wants 20% up front, but 20% of what? 20% of their outrageous balance bill, or 20% of a reasonable bill? The clinic will balance bill the insurance and the insurance will knock down the balance bill and state a low ball, but what their records show is an average cost for the procedure. The insurance pays their agreed percentage of the average cost; the patient is liable for the remainder of the average bill.

It is unusual, but I would not be put off by making a partial payment up front provided that payment is a reasonable one.

That's good advice, never occurred to me to ck with ins. Re: dr pay policy

Have heard of it, especially for elective procedures. Have never heard of that practice in an emergency situation.

Two of my friends have had cataract surgery within the last few months. They had to pay a percentage of the total fee before the surgery date.

Also fairly routine for cosmetic procedures.

I am seeing it more and more. If a personal injury client has med pay provisions through their auto insurance, most of the ortho surgeons now demand payment in full from the carrier before they will perform the procedure. If the client has health insurance, they call the carrier and find out if the deductible has been met. If not, they want the balance of the deductible, and co-pays, in full, before they schedule the procedure.

I checked with my insurance and it has been approved and she is in my network. The person I talked to at the insurance said each doctor has their own policy. And this is not cosmetic but has got to the point where I can't walk for a long period of time or any kind of distance without great pain. I am going to ask them to send me a bill so I have some kind of official paperwork. I am not giving out credit card information over the phone to anyone who calls.

Yep, one of our local hospitals does this and it really angers me.

My husband was having horrible abdominal pain and we went to the ER. They ran several tests, then recommended a HIDA scan to check his gallbladder. They couldn't do it then as it was at night so we were told to come back in the morning and when we got there, we had to pay 600 upfront before they would do the test.

A friend's husband needed his gallbladder removed, another ER case and they took her to billing and she had to pay 1500 before they did the surgery.

I suppose they were able to say it wasn't an emergency as it hadn't ruptured yet.

I try to avoid that hospital if I can but unfortunately, that hospital negotiated with my insurance a few years ago to be the only hospital in network.

I went in today for pre-op. There, i was told my portion of my PREapproved surgery was $1,000+ and would I be paying any of it today? Couldn't have the surgery until it was approved, and they expected payment. Sigh. Life is changing!

This *could* be good for all of us who do pay our bills. Maybe our bills will not be inflated by write-offs for others who can afford to pay but don't, or don't pay in a timely manner. I know I don't pay when I get a 'statement' because I'm waiting to see the final *bill*, once Medicare and any other insurance have paid. (Have you ever tried getting money back from a hospital after all was said and done and you had been billed to much and paid it?)

Yes. My husband had to pre-pay his deductible to the hospital prior to his hernia surgery.

My nephew's son was to have tubes put in his ears. The hospital wanted the whole bill paid in full before they would do the surgery. He told them he had insurance, and it had been pre-approved. Why did they want it up front? He was told that's just the way it is. Nephew called them on it. Said the only reason they wanted it paid up front by him, was because he wasn't on welfare. They wanted him to pay up front to cover someone who didn't have any money. They were not happy. So he went to his son's Dr. (who also did my thyroid surgery and my DS tubes) and told him what the hosptial wanted. Dr. told him not to worry about it. Dr. called the hospital. Didn't cost DN a penny. He was right. That's what they wanted.

Seems reasonable to me. Getting a deposit or advance payment of the patient's share provides assurance that the patient will show for the scheduled time (there's probably a partial forfeiture provision for no shows without advance notice and a good reason) and it cuts down wasted time chasing a balance due and risk of non-collection.

Think of when buying even a cheap car. You can't walk in, drive out, and say "send me a bill".

snidely, the converse of that is, I don't pay for having my home remodeled until it's done. That is, I don't pay for services which haven't been done! Not that you're wrong, it's just that it there is another side ;)

Yes, I've experienced it. It's ok with me.

Yes, we had to pay the hospital the full deductible before surgery could be done on my husband.

Chances are that the 20% they are asking you to pay up front is the full 20% of the insurance allowed amount. Having worked on the billing side of medicine, I can not tell you how many people try not to pay the co-pays in a timely manner - often over months/years while they have $$$ jewelry just dripping off them Often that is because medical practices don't usually charge interest on outstanding balances.

I think they have every right to ask for the normal co-pay or deductible up front.

Rob, a builder has the lien process for protection.

A dentist buddy told me he occasionally collects the patient share before the procedure, often on a payment plan.

I had to do it twenty years ago. I didn't have insurance because my parents insurance had just kicked me off the insurance program because I aged out. The hospital made me put down a deposit and wanted a monthly credit card to bill. My surgery was probably considered cosmetic because it wasn't an immediate health issue although it could have eventually turned into one.

Right, jim Mat.

Rob, the money is paid or held by the party who thinks the other might flake out. With a medical procedure, the service can't be undone or repossessed, or the time slot rescheduled on short notice, so payment in advance from the patient protects the service providers. With a contractor, payments are withheld or made at completion to ensure the contractor finishes. As jim Mat says, the contractor has no risk, collection for his/her work is protected by having a mechanic's lien.

I already said you were right snidely?

ETA: wait. What if they don't do all they said they were going to do? Should i get a refund? That's happened to me. I was to get two implants (health not cosmetic), but only one would work, so I got none. There was another procedure they were doing at the time, so they should get paid some. What if they do more, do they get to charge more? The answer is, they do. So why doesn't it work for the converse situation? I'm not saying it's going to happen, but you can bet they won't fork it back over to you. They won't even refund duplicate payments unless you call and tell them. Ask me how I know. I too have been involved with medical billing. Both in insurance for two decades and as a patient for many decades.

When I had surgery, I was asked to provide the payment not covered by insurance prior to the surgery. Frankly, I understand it. The surgical center and surgeon collected their bit, as did the anesthesiologist. I overpaid for the anesthesiologist and part was refunded. If the surgery had been cancelled at the last second, I'm sure I would have been refunded.

I want a provider (whether dentist or physician) who conducts procedures less like doing an oil change and more like the combination of applied science and art that it is.

If a procedure is started and they find that there's a reason to not continue or to do something else, isn't that the best possible outcome? The charge is for whatever is done, which can involve half of this and 100% of that, different from what was expected if it's right to continue and that was discussed with you in advance.

It was the best possible outcome. Duh!

But this thread was about money. Do you often pay people when they do half the work, because it is the best possible outcome they could offer, or do you expect a discount? Remember, this is fully about money. It was merely a business transaction you've boiled it down to, but put the shoe on the other foot and it's no longer just business. You can't have it both ways. Or, if you're an MD, you can. Apparently.

New here but I experienced this when I scheduled a surgery a few years back. My surgeon explained the deposit by saying that a deposit makes people more likely to show up and follow through with a procedure, if something is scheduled and you fail to show then he/she loses money which isn't fair to them. Apparently lots of people back out after scheduling procedures whether elective or not and that can leave a doctor in the lurch. I'm sure it does not happen all the time but it seems fair to me unless it is an emergency situation.

I live in Canada, we never have to worry about paying upfront, it is all covered by our Canadian Health Plan for all its citizens.

Makes it look like a Dr doubts I would survive surgery to pay him. Being the outspoken person I am I'd ask him where the doubt comes from. Maybe ask him to sign a guarantee of success that would have him return all monies paid from myself and insurance co in the event it wasn't 100% successful. I see it as they can make it tough and so can I. Of course I may hafta find a new Dr.

That's right Amazing Aunt Audrey, p!ss off the doctor before they cut you open. That's really a good idea! And good luck getting that guarantee! LOL I've had such amazing surgeons over the years there's no way I would try to make it tough on them. In fact I try to make things easier for them since they're trying to make things easier for me and in the end they HAVE made things much better for me. And truth be told, they've noticed even the little things such as wearing clothing without metal when there will be x-rays, having questions written down when I go in, being on time for appointments, etc and they have commented that it saves them time.

When we had the stores, our motto was "The customer is NOT always right!" There are certain customers we simply didn't want. Wasn't worth the trouble. There's plenty of other customers out there.

I know the nursing home wanted money up front before they'd allow me in but (thanks to my doctor as a matter of fact) they waived it off. I think prepay is a good idea in a lot of situations. I think you'll be seeing more and more of it. Gas stations had to go to prepay to offset the losses. Too many people don't pay their share and the ones of us who PAY our bills are the losers.

dh had to pre-pay for dental...but haven't heard about prepaying for surgery...

Cynic, I did say I'd probably have to get a new Dr. It does make me feel the way I stated though.

The medical field is not like it used to be. Most doctors in my town are employers now days. They don't make as much money and are stiffed by people who need surgery but can't pay unless they take a stand. It is hard for a person without money to put up that payment which is a lot of money. Life in medical care is a battle for the patient and the doctor who no longer is able to pay himself.

Seeing this message right next to phoggie's "It was supposed to be routine" message makes me wonder if it is partly in case something goes wrong and the patient passes away during the operation, they won't have to wait for the estate to settle before getting paid. Although in the case of a bunion surgery its hard to imagine things going that wrong.

All the doctor's have contracted rates and legally cannot charge more than what they are contracted for. If you read your eobs, you can easily tell what amount is allowed and what is written off and what is the patient's responsibility. What difference does it make whether you pay your portion before or after the procedure? With the amount of people that can sleep at night blowing off their responsibilities, I don't blame them for wanting at least a partial payment up front. I do not believe for a minute it's because the doctor thinks you might not survive!!

Seriously, you think a surgeon wants payment because he thinks the patient won't survive? How about he wants pre payment because of all the bums out there who will not pay the bill but expect the service? I really hope what you said was tongue in cheek. I work with a surgeon who is still waiting payment from the patient 2 years after doing her hysterectomy. So guess what happens? This gifted surgeon will not do surgery without some type of pre-payment. Do you know what the charges are to the hospital to set up and open for a case, and then not have the patient show up? It's over a thousand dollars every time that happens. So that could be another reason for pre-payment.

I'm wondering if patient payment is required by insurance companies to prevent fraudulent charges by medical providers. The hospital cannot randomly bill without proof of a co-pay from the insured. And, I agree with sleeperblues too.

I stand by my earlier complaint while also acknowledging what sleeperblues said.

It is indeed a sad fact that for many people, when money gets tight, medical bills get pushed to the back of the line and frequently don't get paid at all. Unfortunately, those doctors still have a practice to run and employees they must pay, regardless of whether someone has paid their bill or not.

I suppose I pine for "the old days" myself.

For the majority of my adult life, we lived paycheck to paycheck. We could budget to pay you in installments but we just didn't have a lump sum to give you upfront to pay in advance. Hubby and I have managed, over the past 10 years, to work our way out of that lower class (paycheck to paycheck) predicament into a solidly middle class status. Before that, it was (largely) an honor system. We promised we would pay what we could, when we could, until the balance was paid; the doctors took us at our word AND we fulfilled our obligation.

Unfortunately, too many have gamed the system for too long and now, an increasing number of doctors and facilities require full upfront payment.

Luckily for me, I've established a rapport with my regular physicians and dentists and they KNOW I'm "good for it" and they allow me to get needed services and pay out over time if I need to.

I worry for my children though. It has taken years of seeing the same practitioners before we reached a comfortable spot that I could get what I need and they know I won't shaft them.

What will my kids do in 15 years if they are just starting out and can't afford 1000 upfront for, say a root canal and crown?

In 2013 my wife was diagnosed with breast cancer and estimated care was $87,000.00. We paid $3,000, her share of deductible, prior to scheduling the surgery. Very reasonable.

Our new dentist doesn't work on payments or assignments. Prepaid in full is the only option. We joined the Care Program which includes two exams and two cleanings for $400 per person per year. According to the estimated price list, a root canal and crown is $1,975.00. Prepaid of course.

I wasn't seriously thinking that was the the case. It was just a stray thought brought about by seeing the two threads adjacent to one another. Sorry if I offended anyone here. In actuality I think the practice is motivated not by concerns that the patient might be dead, but because the patient might be a deadbeat.

I figured you were joking, Bob but I do admit it hit a nerve. Texas gem, you are the exception to the rule. I applaud you for working hard and paying your bills, but it is just not the case anymore with a lot of folks. I am not involved in the billing aspect of my job, but I have noticed a "tightening of the reins" so to speak regarding payment and pre-payment for procedures. Another thing I think people should be terrified about is the doctors who are now refusing medicare/medicaid patients. Our government has cut the reimbursement to such a miniscule amount that surgeons are just saying "not gonna do it". Had an example just yesterday. Surgeon cancelled a carpal tunnel release surgery because it was either medicare or medicaid. He told me he would be reimbursed 70.00 for doing that surgery--it's just not worth the risk.

Texas Gem, it's my view that the most important job a parent has is to prepare kids for adulthood. That involves teaching them the right attitudes and values, healthy practices, positive outlooks, yada yada yada but it also involves steering them toward whatever experiences, education or skilled trade training suits them so that they find an occupation to support themselves and lead productive lives. Do that successfully and there's no need to worry and you'll avoid the "Failure to Launch" syndrome. What happens if a major expense occurs to one before they're riding their own bike without training wheels? Why, Mom and Dad kick in the needed bucks to take care of it. That's how it's always been.

Sleeperblues, I understand how only the most selfless physicians (and there are few of them) choose to operate Medicare/Medicaid-focused practices for under-served communities. I know that many reimbursement levels are too low. But that's not the patients' fault. Docs are free to practice where and how they wish and I understand how many choose to not have an a practice that includes a significant chunk of public insurance patients. (Although the move to large group practices in so many places changes that a bit). I think all docs have a minimal societal obligation to at least take a few of these patients from time to time and just suck up whatever the financial penalties are. Too many surgeons tend to be cocky anyway, I wouldn't want to spend my days with them as you do.

The lab where I have been going for several years for my blood work, is now requiring patients to pay upfront. Before my blood was drawn, the tech looked up my insurance info and determined what amount my insurance will pay and what my portion will be. I had to pay that amount before she would proceed. My blood work was nearly $1,900 and I had to pay 20%. What the lab does not take into consideration at that point is the discounted rate with my insurance company, only the full amount. The lab agrees they owe me a refund, but it sure takes a long time to get it lol.

That's unreasonable, matti, I'd call your insurance company to get their guidance.

The negotiated insurance discounts I've seen on lab charges can be as much as 75% or more. There's nothing wrong with asking you to prepay your share, but to take a wild-a$$ guess that results in a number THEY know full well is way too much shouldn't be required.

Interesting side note as to costs. I got a letter from my doctor saying the bunion surgery would cost, $18,086. I then went to my insurance's website and they have a 'cost estimator'. They list a range of $9,500-$12,320 for procedure cost and then lists what the insurance will pay $7,593-$9,848.

Which would you like to pay 20% of $18,086 or $9,500-$12,320? Interesting differences.

When it comes to refunds, I am still waiting for one going back to Jan. 6. They double billed us and DH paid it not realizing I already took care of it. I have called several times and I am told that they are aware of it and will take care of it. That is only for $55, when do you think the refund will come when I overpay thousands?