Doctors – Do you think it is okay for you to waive all co-pays and deductibles? I was at a baby shower this past weekend and the lady next to me was talking about going to her Chiropractor. Then she went on to say that since the co-pay on her insurance is so high he does not charge her. He also told her that it was his choice whether or not to charge her because this was just extra money in his pocket. Insurance Investigator Joe would like to know this about her doctor. Technically, it is not extra money in his pocket and he DOES NOT have the option of whether or not he/she routinely waives patient’s co-pays and deductibles. A co-pay is simply the balance of the actual charge, or allowed amount, that was not paid. It is not extra money. Any doctor/biller who thinks this way, needs a class in insurance 101 and a good lawyer. In most states, it is illegal to routinely waive co-pays and deductibles for patients. This practice may initiate charges of health care fraud against the doctor because they are claiming the wrong amount of the service when the insurance is billed. For example, if a patient has a $40 co-pay that the doctor waives, and the insurance company is billed $100 and pays $60, technically the patient’s bill is only $60 total, not $100. In the case of financial hardship, doctors may choose not to collect debts from patients without risk of being charged with insurance fraud. Reserve this ONLY for patients who are suffering a financial crisis or emergency. KEEP EXCELLENT RECORDS of all conversations with the patient as evidence that you made a good faith effort to comply with the law and that co-pay and deductible exceptions were only made for specific reasons. Gather all the information you can about their financial situation. Set up a program with specifics on the care program, charges and discounts provided over a defined period of time. BOTTOM LINE – IN MOST CASES YOU MUST COLLECT COPAYS AND DEDUCTIBLES OWED FROM P

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September 21st 2011 |

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