Why does the hospital want me to make a deposit before I get my care?

At the present time, hospitals and many surgeons and other providers look at your health insurance benefits before they see you for care. Part of what they look at is; where is this person in meeting their deductible and would they owe a lot of money for care received if it is billed to the insurance company first?  Why do they do this?  All businesses want to be paid for the services and goods they provide. Just like you pay for your pizza now on-line ahead of its delivery, quite a bit of healthcare is now paid before or at the time of delivery.

Unlike when you go to the doctor’s office and pay a co-payment (if you are on a PPO non H.S.A.) based plan, for other care needs the cost typically will vary. The providers know what they will get paid usually and generally also know what services will be provided. That is how they determine what your deposit should be. When at the doctor’s office where a co-payment is due that is a fixed amount based on the plan’s benefits so the co-payment is handled a bit differently because it is a set fee paid not a deposit.

When you have a large deductible that is not yet met, the providers want to ensure they don’t provide you with either uncompensated care or provide you with a free loan. In order to protect from these situations they require, and the insurance carriers typically allow, a deposit against the cost of the care.  The deposit should be no more than you would owe based on how much of your deposit is already met.  You should not be asked to fund the full procedure with refunds coming after insurance processing of the claim, unless that amount is less than what you still owe on your deductible.

You should always know how much you still owe towards your annual out of pocket maximum. Keep in mind with most plans co-payments do not count towards these maximums, they only capture deductible and co-insurance. It should be easy for you to track and needs to be tracked to make sure your and the insurance carrier numbers match.  Remember in-network and out-of-network maximum out of pocket costs add up in different buckets, so often if you use services in one of the other it does not necessarily fill both buckets.

If you are going to the hospital for elective surgery, scheduled well ahead of time, you will almost always spend some time at the hospital ahead to conduct pre-operative reviews. These reviews are medical and financial.  At this time the hospital staff will conduct a check of benefits and see where you are with regard to meeting the maximum out of pocket.  They will then discuss with you the expected cost of care and where your personal costs are expected to be. At that time they will ask you to pay a deposit for your expected out of pocket costs.  They may be able to work out a payment plan, and the best time to ask for such is at that time.

Healthcare is expensive to obtain and for most providers to provide. To that end the providers are just ensuring they are going to get paid for their services and goods provided. That is why you are asked to pay a deposit for care in many cases.