The self-pay challenge

As health care costs continue to rise, so does “self-pay” or the patient responsibility, in the form of higher premiums, higher deductibles and higher co-pays. With these rising costs comes an increased burden on medical practices: Successfully collecting self-pay.

Compared to co-pays, self-pay items like deductibles can take more than four times as long to collect, and 18% of deductibles and other self-pay collections have been known to ultimately get written off as bad debt.1

Increase in patient deductibles 2009-2011*

Self-pay collections such as deductibles represent a significant percent of a physician’s contracted rate, as shown below for the following specialties:

Ultimately, half of all overall patient responsibility goes uncollected because self-pay payments are not among patients’ priorities when money is tight. Research has shown that patients will prioritize mortgage, insurance and utility payments over self-pay medical bills from their doctors’ offices. Health care is the third most likely category to go unpaid by people when they are short of money.

This combination of patients’ higher costs and lower prioritization among their expenditures creates the “self-pay challenge” that caregivers face today. But a self-pay policy, along with the right self-pay tools and technology, can make a positive difference for practices.

*Increase in deductibles as a percent of total allowables from 2009-2011. Based on claims data from athenaNet, totaling about $15B in charges.   

1 Kim Lafontana and Kim Williams, “Practice Management Lab: Finding Success with Self-Pay,” 

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