General Category > General Questions
Legal? can you waive out of network deductibles?
JenniferPT:
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:
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:
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:
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:
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.
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