Anthem Health Care

There are so many reasons why you should not waive copays or copayments. If you are contracted with the insurance company, you are bound to follow what is in your contract with them. A patient’s copay is due at the time of service! You must collect your patient’s copay!

Let me tell you why you should not waive copays!

Your contract says you collect copay at the time of service!;
Your patient knows they have to pay their copay based on what their policy says (it’s absolutely false that they do not know they have a copay!);
Your are actually losing money in your practice if you do so!

What is a copayment? It’s a part responsibility of the patient’s based on their policy and coverage. Mostly, their copays are applied towards their annual out of pocket amount for family, single or individual.  And it is always due at the time of service (the time they came in to your office). Copay for Primary Care Physician and for Specialist Office may differ too!

So why do you think you should not waive a copay? — let’s take a look at this way:

Assuming the insurance payor allows .00 for an Evaluation and Management – E/M Code and you waive a copay of .00, you only get reimbursed at .00 because the .00 was applied towards the patient’s copay.

So why waive the copay when it is an actual additional revenue to your daily cash flow, is it not?

Here are some scenarios of problem collecting copays and what you should do to deal with these:

The Patient has a Secondary Insurance and would like you to submit his/her claim to the secondary insurance after the primary insurance pays for the claim — what you should do; explain to the patient that their copay is due at the time of service regardless if they have a secondary insurance! Most of my patients would even send claims to their secondary to pick up for their copays. The key here, educate them!
The Patient always “forgets his/her checkbook” — give the patient one chance! Again, explain to them their copay is always due at the time of service. Hand them a self-addressed envelope and let them mail a check as soon as they get home. Or know your area, I’m sure there is a bank or an ATM Machine nearby, you can let the patient go the nearest  ATM and withdraw money. Or for their convenience too, if they have credit cards — your practice should be able to accept major credit cards.

 Helpful ideas too, post in your waiting room and at the window that says “Your Copay is Due at the Time of Service”,  “You Must Pay Your Copay Before You Can Be Seen”.

And here is your last course, it is alright too to refuse to see the patient if they do not pay their copay. Maybe on the 3rd visit, if obviously the patient have been deliberately “forgetting” his/her check – inform them when you make the confirmation before their appointment that they can not be seen if they do not pay their copay balance.

I don’t think you can purchase any material thing that you use them first before you pay for it. Realistically,  why render the service before the patient pays their copay? A private physician practice is not running a charity program or else you will go out of business. Just my one cent  idea.

The Author is a Professional Medical Practice Billing & Coding Consultant. She has extensive knowledge and skill in the area of Pain Management, Physical Medicine & Rehabilitation, Anesthesiology, OB GYN, Physical Therapy and Dermatology.Read more about the author as she share her knowledge and expertise in her field by visiting her personal website at http://www.justmypassion.com and her blog at http://justmypassion.blogspot.com