General Category > General Questions
Collecting Copays and co-insurance
Tifsmom1:
I am in the state of Colorado, I was told that it is illegal for a provider not to collect a patients co-pays and co-insurance and deductibles. Is this true and if so where can I find this information. I have checked DORA.
rdmoore2003:
Read your insurance contracts. Basically, when you do not collect, you are jeopardizing your contract with the insurance company and the contract between the insurance company and patient.
rdmoore2003:
also jeopardizing your office's cash flow. Once the patient leaves the office and doesnt pay at time of service, chances decline on getting your payments from the patient.
Michele:
RDMoore is right, but not only is it jeopardizing the contract with the insurance carrier it is against the law.
All of these concepts, deductible and co-insurance, are cost share obligations. The rules of managed care state that the patient CANNOT see the doctor until they make their co-payment. Managed care is governed by federal law and is not open to interpretation. To "write-off" a co-pay, or to allow a patient in to see the doctor without collecting the co-payment, is against the law.
Basically, providers are not supposed to 'forgive' patient responsibilities without proof of financial hardship.
shanbull:
Not collecting copays/coinsurance/deductibles may constitute breach of contract and fraud. These blog posts from law firms that specialize in this area offer the best explanations I've found about this so far:
https://www.kirschenbaumesq.com/article/collecting-co-pays-required#sthash.uiqFkMLy.dpuf
http://www.ober.com/publications/2472-health-care-providers-may-waive-patients-copayment-obligations-but
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