Author Topic: Legal? can you waive out of network deductibles?  (Read 7837 times)

JenniferPT

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Legal? can you waive out of network deductibles?
« on: November 05, 2012, 11:55:34 AM »
A client told me of a physical therapy place she went to that would waive the smaller out of network deductibles, $500 and under, because they would hit that amount usually after the first two sessions. 

Is this legal?   

DMK

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Re: Legal? can you waive out of network deductibles?
« Reply #1 on: November 05, 2012, 12:10:39 PM »
No no and NO!  If you are a contracted provider you have agreed to charge deductibles and co-pays and accept the allowed amounts for your services.  The patient has agreed to pay their deductible and co-pay amounts.  It's a contractual agreement that the provider CAN NOT waive.  That's what's known as a kick back, and Medicare will come down on you with both feet!

While I appreciate the facility wanting to be nice and help out clients financially, they CAN'T and still remain within the boundaries of their contract with the insurance company!

JenniferPT

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Re: Legal? can you waive out of network deductibles?
« Reply #2 on: November 05, 2012, 12:20:24 PM »
If they are not in network with the insurance company...the OUT of network deductible.   I full understand it's illegal to do that for an in network deductible.

DMK

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Re: Legal? can you waive out of network deductibles?
« Reply #3 on: November 05, 2012, 01:17:04 PM »
If the patient is using their insurance, then it goes against THEIR contract with THEIR insurance company.  The provider can still get in trouble for kick backs.  Especially if they have even 1 Medicare patient.

JenniferPT

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Re: Legal? can you waive out of network deductibles?
« Reply #4 on: November 06, 2012, 08:41:35 AM »
Gotcha.  I think he was under the impression that since it's out of network, the provider could not collect deductibles.   I doubt they even considered the patients contract with their own insurance company.   

DMK

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Re: Legal? can you waive out of network deductibles?
« Reply #5 on: November 06, 2012, 10:48:16 AM »
You may find some insurance companies that have an in-network deductible and an out-of-network deductible.  (Out is often MUCH higher!) 

I know that more and more facilities are dropping their insurance contracts.  The provider will have to look at their patient base, and area trends, and determine whether it's in their best interest to be in-network or out of network.  (We, personally, wouldn't have much business if we did not participate in every possible plan as most of our community isn't financially able to go somewhere that's not in their network.) 

We have certain physical therapists we refer to based on the specific injury and patient's still make sure they take their insurance.