Author Topic: Copay Dilemma  (Read 5096 times)

Alice Scott

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Copay Dilemma
« on: March 07, 2008, 08:55:12 AM »
Hello ladies :) I'm not sure of what to do about a co-pay dilemma.  We are
participating providers with BC BS and bill them $35 for a chiropractic
adjustment they allow $28.50. My question is this... We are finding that
quite a few of our patients co-pays are now 30,35,and 40 dollars now. Can we
just by pass billing the insurance and just charge the patient? If we are
going to not bill the insurance can we charge the regular office fee or are
we only allowed to ask the amount the insurance allows which is LESS then
the co-pay?

   This is a common situation now.  The copays are more than the allowed amount.  Technically if you are a participating provider, you are required to bill all services to the insurance company.  There are other things to consider.  If the patient has an out of pocket benefit, your visits will be applied to that, etc.  If you choose not to bill the insurance company and they find out, they can terminate your contract. 

Also, if you don't bill the insurance carrier, but you charge the patient more than the insurance allows, $28.50, you present yourselves as par with BC but yet you are charging greater than what BC says you can charge, so again, they could terminate your contract.  If you don't want to bill them, then you would need to stop your participation status.  I'm assuming that some of the plans still pay and that may not be a good idea for you either.

Anyway, I hope this helps you in deciding!

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Copay Dilemma
« on: March 07, 2008, 08:55:12 AM »