New Hampshire: Can you Collect that Consumer Directed Health Plan Deductible Up Front?

There are a “plethora” of articles encouraging providers to implement “up front” collection techniques to save billing expense, increase cash flow and take advantage of the provider’s best opportunity to collect. Given the increase in insurance offerings featuring high deductibles, you will want to be able, whenever possible, to collect your deductible at the time of service. Some payors offering high deductible health plans (“HDHP”) offer tools that will allow you to verify whether the deductible has been met in “real time”. Others have language that expressly prohibits you from collecting the deductible until the payor provides you with an EOB stating the amount due from the patient. You will also need to look to your state laws.

Look carefully at your state law language requiring payors to include a patient “non liability” or “hold harmless” clauses in their agreements with providers and practitioners. In New Hampshire, that clause is found at RSA 420-J:8 I(a) and reads “Provider agrees that in no event …shall the provider bill, charge, collect a deposit from, seek payment or reimbursement from or have recourse against a covered person or a person acting on behalf of the covered person (other than the health carrier or intermediary) for services provided pursuant to this agreement.” Even though New Hampshire law expressly allows providers to collect deductibles, this prohibition on deposits has been interpreted by the New Hampshire Department of Insurance to prevent a provider or practitioner from collecting the deductible from a patient at the time of service unless the provider has real time knowledge about how much of that patient’s deductible has been paid.

For those plans that do not offer real time information on how much of the deductible has been paid, can you record the patient’s credit card number at the time of service and enter into a credit agreement with that patient allowing you to charge their credit card once you receive that plan’s EOB? Not if this is seen as a deposit. As of this writing, I am told the question of whether holding a credit card number is the same as taking a deposit has not been settled at the New Hampshire Department of Insurance. It might depend on whether the provider or practitioner is asking for the credit card number as a matter of convenience and time saving for the patient or whether the practice would deny service to a patient who refused to provide the credit number and sign the credit agreement.

04/12/07  See updated information at Today's Post