Letter to Editor: Processing Patient Refunds

Recently in the Tampa Bay Time, Columnist John Romano wrote an article titled "Doctors Should Send Refunds as Fast as Bills". We read his column with interest and wanted to provide our perspective as physicians and business owners.Romano’s suggestion is that physicians don’t send refunds to patients when they receive payment from patients’ insurance and that is “double dipping” by the medical practices. As a medical practice that has provided care to patients throughout the Tampa Bay area for over 30 years, we beg to differ with Romano’s perspective and here’s why.

In the first place, determining precisely how much an insurance company will reimburse a doctor for treatment provided to a patient is no easy task. The complexity of regulations and individual insurance company guidelines that dictate how much will be paid for a particular service, on a particular day, surrounded by a particular set of circumstances, and based on the specific contract negotiated by the doctor, is staggering. Each insurance company has an infinite number of benefit options and combinations of reimbursement patterns and the number grows regularly. The only real guideline that can be used to pin down what a doctor may be reimbursed is to assume that for every regulation/guideline there is at least one and often multiple exceptions.

As doctors and owners of a small business, we understand the need to balance the provision of quality care with the need to maintain financial viability. We work continuously, to identify how insurance companies make reimbursements and factor that information into our operations. We fine-tune our computer system’s database to keep pace with changes in reimbursement patterns and monitor reimbursement trends to make sure we keep up with the ever-changing reimbursement patterns of insurance companies.

When a patient makes an appointment with our practice for care, we identify the reason for the visit and estimate, based on our most current understanding of their particular insurance coverage and the reimbursement pattern of their insurance company, what the visit will cost. By factoring in whatever we believe the patient’s insurance will more than likely pay for the care, and including the amount of any patient obligations for a co-pay or co-insurance, we arrive at the amount the patient must pay and we collect that when they check in.

As Romano suggested, we then file a claim with the patient’s insurance company and, eventually, receive reimbursement for some or all of the cost of the care. Once the insurance company has paid its portion of the claim, we determine if we have collected too much or too little from the patient. If we have collected too little, then we bill the patient for the balance due. If we have collected too much, we promptly reimburse the patient for the difference between what we collected and what was actually due unless the amount to be refunded was so small it is cost-prohibitive to process. In those cases, we deduct what is due to the patient from what they need to pay on their next visit.

Patients often comment on the fact that we are the only medical practice they visitthat makes refunds without being asked. Our accounting processes are designed to ensure all patient accounts are accurately reconciled and refunds are made in a timely manner so that patients receive refunds prompt. This also means that as business owners, we have a clear and accurate picture of our financial condition at all times.

Not only do our patients comment on the fact that we make refunds without being asked, they also comment on the fact that, once the refund is issued, if the check is not cashed in a timely manner, we contact them to remind them to cash or deposit the check!

We’re glad Mr. Romano’s article highlighted the need for medical practices to establish and maintain responsible financial policies that call for careful calculation of how much to collect from patients and we regret more of our fellow doctors do not complete the accounting cycle by identifying when a patient has been overpaid and make prompt reimbursements. As for our practice, we monitor reimbursement levels daily and regularly make refunds as soon as we are sure they are owed – without being asked!

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