Author Topic: Co-payments on Well Visits  (Read 2957 times)

ortsok

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Co-payments on Well Visits
« on: March 29, 2012, 09:56:23 AM »
Here in Massachusetts most of the insurance companies do not apply a co-payment to a well visit.  The patients are aware that they do not get charged a co-payment, However, if the doctor treats a symptom then the insurance company applies the co-payment and we then later bill the patient.  I have been running into time and time the patient complaining about this.  Wanted to know if other offices run in to this and if so, what do you do?

PMRNC

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Re: Co-payments on Well Visits
« Reply #1 on: March 29, 2012, 10:49:11 AM »
Mass Health reform = State wide Obama Care :(

That aside. LOL

Yes, this is probably more common than you think. I do pediatric billing so I run into same situation from time to time. I just simply tell the patient that their insurance company requires a co payment for that date of service and I explain why. If they still have a problem, I tell them they have to contact their insurance company, but it's clearly addressed in their policy booklet. On occasion I will tell the patient if they bring in their policy booklet to the provider, I would be happy to point out to them where this comes into play (cost sharing provisions) 99% of the time this does the job or they contact the carrier. Either way it's not our problem and the patient is still going to be billed. 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

ortsok

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Re: Co-payments on Well Visits
« Reply #2 on: March 29, 2012, 01:35:13 PM »
Thank you.  That's what we have been doing here.  However, today I'm running up against one of the doctors not wanting the patient to be billed the co-pay and for us to adjust it off.  I don't think that this is okay.  Didn't know if you had anything from the world wide web that I could reference to him to show we cannot just adjust off the co-pays.

PMRNC

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Re: Co-payments on Well Visits
« Reply #3 on: March 30, 2012, 11:32:34 AM »
There's a fine line. I call your particular situation "TWIPPING"  Take what insurance pays.  If done routinely it can be considered fraud/abuse. To avoid these situations LATER (after carrier has been billed and paid) every office should have a financial policy in place that patients see ahead of time so they know what to expect and to avoid these instances. IF a patient has a hardship, it should be clearly documented along with a signed financial hardship form. If the practice has a financial policy in place it should be strong adhered to. If there is no financial policy in place.. GET one, it's VITAL.   The short answer to that one case would be it would be ok, however if he plans to waive THAT co-pay he will need to have patient sign something to indicate it was a one0time only thing. I don't need these because every one of my clients has a financial policy and I'm all over them if they want to stray from it. I make them go over it every year along with all office policies and procedures. With a system in place, you never have these questions come up.  Now let's say he wants to waive their copay's indefinitely.. NO, he cannot do that unless he gives the insurance carrier the same discount which defeats purpose because the patient's policy still contains legal structure for collection of out of pocket, this clause is called "Cost Sharing" to which the insured is obligated to pay their share of copay's/coinsurance and any deductibles.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Jmari3

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Re: Co-payments on Well Visits
« Reply #4 on: March 30, 2012, 12:05:25 PM »
So, it doesn't matter who the patient is a Doctor can not do this on a regular basis?  I worked for a Chiropractor and he would do this for all of his family members.

PMRNC

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Re: Co-payments on Well Visits
« Reply #5 on: March 30, 2012, 01:06:46 PM »
Quote
So, it doesn't matter who the patient is a Doctor can not do this on a regular basis?  I worked for a Chiropractor and he would do this for all of his family members.

Most carriers will not cover family members of the provider, but if they did, yes that is considered fraud/abuse. If their insurance doesn't cover family members but they submitted the claims anyway and carrier didn't know they were family, that is another case of fraud.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Jmari3

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Re: Co-payments on Well Visits
« Reply #6 on: March 30, 2012, 05:30:42 PM »
Wow, ok,  thank you Linda.   :)