Medical Billing Forum

General Category => General Questions => Topic started by: bsmedbilling on May 25, 2011, 10:32:48 AM

Title: Copay
Post by: bsmedbilling on May 25, 2011, 10:32:48 AM
Hello everyone,

Can the provider waive a patient's copay with private insurance?

Thanks,
Bsmedbilling
Title: Re: Copay
Post by: DMK on May 25, 2011, 11:47:45 AM
If they are a contracted provider, they are required to collect co-pays and deductibles.  The patient also has a contract with their insurance company agreeing to pay their portion.

The doctor can take payments towards the balance due (ex. $5.00 p/month if that's all the patient can afford) but they can not "waive" co pays.  It's considered a kick back.
Title: Re: Copay
Post by: bsmedbilling on May 26, 2011, 02:47:43 PM
Thanks much :)
Title: Re: Copay
Post by: Michele on May 31, 2011, 06:42:24 AM
DMK is absolutely right.  The only exception is in the case of a financial hardship but it MUST be well documented and in the patient's chart.  It cannot be because the patient is his wife's cousin or daughter's boyfriend's aunt, etc.  And the hardship cases can't be forever, each copay must be documented.
Title: Re: Copay
Post by: Meli on May 31, 2011, 06:14:57 PM
Anyone ever have an issue communicating this to a provider?  I have but the explanations I found here a few months back took care of that.
Title: Re: Copay
Post by: Michele on June 01, 2011, 06:47:42 AM
Some providers don't like to hear it or don't want to follow it, but it's pretty clear cut if you explain it to them in these terms.  I find that some providers are compliant (in all areas) and easy to work with.  Others, not so much.  I like to work with the first!
Title: Re: Copay
Post by: DMK on June 01, 2011, 05:56:49 PM
And I really appreciate the kindness of doctors who want to waive co-pays.  But they truly need to understand that they DON'T HAVE A CHOICE!  As soon as you're contracted you must adhere to the contract or face penalties. 

In the Chiropractic "industry" lots of doctors are going off all plans thinking that they won't be subject to record review from any insurance company.  The problem is, when the patient turns in charges to their insurance company for reimbursement, the insurance company can still request records!