Once upon a time people with health insurance could enter a doctor’s office and feel assured of obtaining treatment even if they didn’t immediately have enough money to pay their entire deductible for the care they were about to receive.  

A friendly office administrator would ask the patients as they left if they would like to pay at that time. And it was perfectly fine for them to decline, leave the office, and save payment for another day. Often, doctors would not even know how much extra the patients owed until after the bill was submitted to the insurance company.  

But it is now foreseeable that there will be a time, possibly in the very near future, when that will all sound like a fairy tale. Enabled by more advanced technology and faced with more and more uncollectible debt, some doctors are demanding payment in full for services before they are rendered.  

According to the Medical Group Management Association, a doctor’s trade group, uncollectable debt for multispecialty practices rose nearly 15 percent between 2008 and 2014. Several factors have contributed to this increase, including the recent economic downturn.  

People across the country, including perhaps those in New Hampshire, with less disposable income are trying to save money wherever they can, and patients are turning to high-deductible health insurance as a partial solution. Then, when they run into unexpected medical conditions that require operations, therapy and other significant medical treatment, they are often finding themselves responsible for paying high out-of-pocket payments. This often unmanageable debt sometimes leaves patients with no choices but to settle debts for less than what is owed and/or consult with bankruptcy attorneys about their options.  

Doctors are increasingly noticing this trend. Now computer technology allows doctors to connect with the patient’s insurance company electronically to determine in advance how much the deductible will be. They may then require a patient to pay that amount right away. Some say that this trend could have troubling consequences on access to health care.

Source: New Hampshire Public Radio, “With medical debt rising, some doctors push for payment up front,” Jenny Gold, April 28, 2014