Letter to the Editor: Why am I asked to pay a portion of my Winneshiek Medical Center bill at the time of service?

(The following is a Letter to the Editor from Winneshiek Medical Center Chief Financial Officer Lynn Luloff):

"For years, it has been standard practice to register for a medical appointment and proceed to the waiting area to be called.  Part of that standard practice in the health care industry today is to ask patients to make payment arrangements and collect a patient's co-pay and deductible payment at the time of registration.  Driven by changes in reimbursement models in insurance plans, patients today have a financial responsibility in their health care costs.

Most insurance plans today require health care providers to collect co-pay and co-insurance balances from patients—balances are defined by their individual plan.  When a patient agrees to participate in an insurance plan by paying insurance premiums, they are also agreeing to defined deductible and co-payment amounts for both in-network and out-of-network providers.   A co-pay means a patient owes a set amount of money up-front, when they register for an appointment. If your plan has co-pays, the amounts are generally printed right on your insurance card.  Co-insurance means a patient owes a percentage of their total bill for the covered service after the deductible is met.

Winneshiek Medical Center and other health systems have contracts with many insurance companies so they can be considered an in-network provider for patients.  To remain compliant with these contracts, health care providers like Winneshiek Medical Center are required to collect a patient's co-pay and co-insurance payment.  Doing this at the time of service allows Winneshiek Medical Center to efficiently collect their agreed-upon reimbursement while trying to save overall health care dollars.  This process keeps costs as low as possible for patients.  As an example, the total cost for WMC to prepare and process a statement is approximately $27.  If all the statement contains is the balance for a $20 co-pay, we are able to save health care dollars and provide a better value to our patients by collecting that amount when they register for an appointment.

Winneshiek Medical Center tries to be as helpful as possible when it comes to submitting claims to your health insurance carrier.  That is why we regularly ask for your insurance card at registration to make sure we have the most up-to-date information on file.  Additionally, Winneshiek Medical Center uses software to help us obtain a few details about your plan; sometimes this will include co-pay amounts.  If there is no set amount because you are under a plan with co-insurance, or your co-pay amounts are not available, we collect $50, which will apply to your deductible and any remaining balance.  Health insurance plans are all different.  It is important for patients to understand their plan, what they will owe for services and how that payment should be made.  Knowing your plan will also allow you to take full advantage of the plan, including annual preventive health services that may be available at no additional cost to you.  Talk to your insurance representative or employer to learn more about your own health insurance plan so you can make informed decisions for you and your family."