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Payment challenges multiply for plastic surgeons

Because of high-deductible health insurance policies and rising co-payments for services, patients are digging into their pockets a lot deeper the past few years. For physicians and hospitals, collection of standard medical bills now looks a lot more like the cash business that dominates the plastic surgeon business model.

“When someone comes in to see me for a breast augmentation, I can offer them a single price which captures my fee, the anesthesiologist’s fee, and the facility fee,” said Vikram Reddy, M.D., an employed plastic surgeon at Henry Ford Macomb Hospital in Clinton Township. “With the advent of high-deductible health plans, patients are increasingly trying to ask what things cost, and hospitals are struggling to meet this demand.”

With the growing number of high-deductible policies, Reddy said, doctors and hospitals need to carefully explain out-of-pocket costs to patients so there won’t be surprises down the line.

“I know my total cost, but for a breast reconstruction, patients need to know their insurance costs. For (some health insurers), 50 percent is out of pocket,” Reddy said.

But for non-hospital employed, office-based plastic surgeons like William Stefani and Mark Komorowski, collecting out-of-pocket payments for elective cosmetic procedures has been a way a life. They have always operated mostly on a cash, or private pay, basis because health insurers often limit coverage to reconstructive and non-cosmetic emergency services, with some exceptions.

Over the past several years, Komorowski said overdue bills from patients also have been growing because of movement to higher-deductible policies.

“If I don’t collect up front, I probably will never see it,” Komorowski said. “They will go into collections, but there is a time limit on that. We are forced to collect up front. Insurers should be required to collect that because they have contracts with patients. I don’t make anything on the premium they collect. I shouldn’t be obligated to collect the…

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