Today, a patient embarked on an all out battle with my receptionist because she believed that she should not be required to pay her copay. She stated that it is ridiculous that she has to pay a copay every time she has an office visit. I hear this complaint often. Many patients simply don’t realize that doctors have no control over whether or not a patient must pay a copay, deductible or co-insurance.
Why must patients pay their copays and other financial responsibilities?
-Patients have a contract with their covering health insurance company that they will be responsible for certain parts of their health-care. There is nothing hidden here. When a patient signs up for insurance, they receive a packet telling them what their obligations are.
– Doctors also have a contract with participating insurance companies. It is not optional for us whether or not to collect a copay. We are obligated out of contractual obligations. If we fail to carry out our duties outlined in our contracts, the insurance companies can drop us as participating providers.
– Worse still, if we neglect collecting a copay or other patient financial obligations from patients, we are guilty of committing fraud. We would be in violation of federal anti-kickback laws because this would be seen as a financial incentive to patients to choose us for medical services. We potentially could face fines, jail time, and/or lose our licenses to practice medicine.
– When a patient tries to demand to get out of their financial obligations that they agreed to with their insurance carriers, it erodes trust and the doctor-patient relationship. As a physician, I want to spend my time in the exam room concentrating on the health of my patients, not arguing over financial matters.
-Many patients that argue over their copays are clearly not doing so out of financial difficulties but rather they just don’t want to pay. Why should people pay their plumbers, their auto mechanics, their hair stylists without argument but, not expect to pay for their health-care?
-With the passage of the ACA, many insurance plans are requiring patients to pay high deductibles. I agree that this is burdensome but, again, doctors are not the ones controlling this: the insurance carriers are. If you don’t like the deductible for a certain plan, don’t sign up for it. If you do, you are obligated to pay it.
– Many patients claim that their earlier doctors never collected a copay from them so they think no doctors should expect to collect copays. First, doctors will think they are lying. Second, if they are not, those other doctors are guilty of committing fraud and violating federal law. Maybe they feel comfortable doing that. But, I and most other doctors have more integrity than that. We practice in the letter of the law.
-Patients who are having financial difficulties are an exception. However, the law requires that we collect certain financial information proving the hardship and keeping these records on file. Otherwise, writing off any patient responsibility is a violation of our contract and breaking a federal law.
I have heard patients complaining that doctors are greedy expecting copays at every visit. Putting aside federal law and contractual obligation, do they go to the gas station and pay every time they fill their car with gas? Are they required to pay the plumber every time he comes to fix a clogged toilet or sink? As a consumer, can they walk into a grocery store and demand free services and expect to receive goods without any charge? Why do some patients place so much less importance on their health than these other items?
Copyright secured by Digiprove © 2015 Linda Girgis, MD, FAAFP
I will say, sometimes call your insurance and ask for an appeal! Yes, you can do that. Personally I had a lab bill with my responsibility being quite a bit, My insurance will cover stand alone labs 100 percent but Asante owns most medical labs in our county so since there were no stand alone labs near me my insurance filed an appeal that was approved. They are now paying my portion of labs. I do this every time I have labs and they cover my portion now, so far. I do however always call before hand and look on my portal to see if there are any stand alone options within 75 miles of me. Please always be friendly to the people trying to help you. I will say I was upset at my husband for paying a bill for our grown son. We had no contract or paperwork with them, it wasn’t our bill our grown son is over 21 and not on our insurance so when they came after us for his copay we should NOT have paid it. They misplaced his info and only had our information from when he was a minor on hand. That’s a copay we should not have paid.
Copays is just part of the problem. The USA has the worst health care system in the world.
Then they expect the patient to pay, as if the money will come out of the sky.
Rather instead, there are not millions of people in the USA who simply do not pay the copay and nothing really happens. Just joint this group.
Once they try to come after you.
File for a debt validation letter and ask for every single document proving that you owe the debt.
Then if the collection company responds, Tell them that the debt validation letter has mistakes and tell them not to contact you again. Under the CFPB law they can’t.
Then if they take you to court. Go to court and deny the charges, for shoddy health care which is ‘
very hard to prove on both sides and deny you own the money.
When the Judge rules against you, appeal it to a trial by Jury, and very very expensive for the court and the the doctor. At that point most will accept a settlement….
If millions of people do that, there will be social change and you won’ t have to pay the bill at all.
I’m still shaking my head at my experience. Anyone who has had a colonoscopy knows what you go through for the exam. Much to my disbelief when I signed in for the procedure I was told if the exam is normal there’s a normal co-pay but… if there are polyps or anything different my insurance would pay up to $3900. There’s zero knowing what can happen. I had to decide if I wanted to go thru another cleansing or bite the bullet. I felt lucky and fortunately didn’t have to pay more. By the way they charged my insurance over $19k. It’s not the health insurance that needs to curtail costs it’s definitely the healthcare. It’s too bad we all have to overpay due to non-covered (I get it) but where I’ve lived it’s the non-citizens who really cost is. ER waiting rooms are about 90% non-citizens. We wait for 4+ hours most times. Hardly a good system.
Paying a copay isn’t like going to a gas station and paying imagine you get on to a monthly gas program and you pay monthly 150 dollars for gas and when you go to the gas station they want to charge you 25 dollars every time you go for gas is that fair no isn’t fair. I think copay is wrong because the health insurance charges us for insurance health insurance and we pay them or it is taken out from your paycheck. Is not right if we paying the health insurance and then we have to pay the Dr a copay smh.
My doctor’s didn’t ask me to pay my copays until the end of the year, which came to be about $900. Are they allowed to do this? Aren’t they supposed to collect it at time of visit? Now that 6 months has passed since my first visit, am I obligated to pay this bill?
Unfortunately, you’re still responsible for that amount and yes, most offices collect it at the time of the visit. Best of luck to you,
Dr. Linda
What if I don’t have a copay on my insurance and a office is demanding I pay one? I’ve never paid a copay, as we don’t have a copay for any office visits since I was put on my husband’s insurance plan 2.5 years ago. The clinic in our town demands I pay a copay regardless. How is this okay?
I took my daughter to physical therapy 1 1/2years ago. At her first visit they had not verified our insurance, but at her last appointment they had. I paid in full what I was told I owed. Now I received a call from the PT office saying they were wrong and charged me the wrong copay and I owe them $600. How can this be legal? If I was told initially how much the copay was, I would not have taken her so often because I could not afford it. I am going to be sent to collections for their mistake.
I don’t mind copay! But why do I pay a copay for the same issue over and over when it is supposed to be cured? And using the grocery analogy!
1. I don’t pay for groceries before I get the groceries, I pay when I depart!
2. If any of my groceries are bad/spoiled, I don’t pay for them again!
I have Medicare and used to have Medi-cal as a secondary insurance, until I lost it in May of 2018. I had asked the office manager at the time, what would happen if I needed any lab work, any outside MRI’s that would not be covered in their facility. John, had told me to go to a certain facility, where I can schedule the MRI, the copay would be waived, as long as I mentioned his name to the director. By the way, I knew who he was. John also told me that if I got a bill from their office, to mention it to him, he would waive the balance.. I wanted to believe what he said at the time , because I felt so broke at the time..
Time passed, an incident happened, where staff was rude to me. The rude staff called John up, backed her up. It had something to do with me walking in to their lab, not fasting. I told the staff, my doctor ( am outside doctor ) does not care if I am fasting or not. Yet, my opinion did not matter. I went ahead and mentioned this story to the doctor.
I had my last appointment with this physician, told myself I will not come back here, due to lack of respect for my being a patient there.
The next thing I know, I get a bill in the mail for $39.45. The balance was highlighted, by the way. I have been a patient here since 2012. I am pretty sure that John knows who I am.
I paid the bill, no questions asked.. thinking that is all that I owe the office, right? Well, guess what? Another bill comes in today for $ 21. 23… Again , highlighted.. I am thinking, how many more bills are coming? Why one at a time?
Is this retaliation because I complained?? I mean now that I got a bill, how many more bills will be coming? I want to know how many more patients he promised (John) that they do not have to pay the copay… GRRRRRRRR
I have a general question. I pay my co-pays and the billing group records it wrong and then sends me a refund check in the mail refunding my co-pay. Then they bill me again saying I owe the co-pay. This has happened several times and I’m sick of it. I have not cashed the checks they sent me but I’m not sending another check to them. What is my responsibility.
Sounds like there is a problem with the practice you are going to. Your responsibility is basically whatever the insurance company says you owe. If your doctor is in network, they can only charge you what they agreed to with the insurance company. I think if you didn’t cash the checks that were refunded for what you paid, you should be paid up.
Dr. Linda
Because it’s BS to tell the patient you’re well and collect $25 for 1 minute of you’re time. It is highway robbery. Nobody wants execuses why you think it’s the same as pumping gas. You can’t place value on an over educated opinion. Especially when you are just practicing. Not always the right diagnosis!! Let’s get the facts straight. With insurance that’s why there has been all this back and forth between administrations because they know it’s a crooked system collecting off the innocent. Still trying to fix it!
It is annoying when you are later sent a $90 bill just for a ten minute checkup and urine sample though on top of the copay. Insurance is a scam.
We have a situation where we are actually out of money. The PC doc sent us to various specialists based on…it might be this or it might be that. There was imaging required for each place we went. Now we have no money…literally none till next check and have to cancel appointments that may, or may not save our lives. What is the correct procedure? Is you answer “Tough, you should have a nestegg”? The doctors have taken our nesteggs by the tens of thousands of dollars. Now what? Tough? So what, you’re old and on a fixed income, so you get third rate care?
Just FYI…you are responsible for the insurance plan you signed up for and fine details involved. Get yourself educated on your own financial obligations with the insurance company. That is your sole responsibility. A receptionist will not and should not do this. From a doctor’s perspective, the only gauranteed payment is the co pay you are required to pay (which can range anywhere from just $5 to $45 or more depending on the plan YOU chose. In the meantime there is haggling back and forth with insurance company just so that they can pay what they are obligated pay- which can sometimes takes months just for one visit. In the meantime, your doctor has to pay a multitude of costs to operate their practice- biohazard fees for labs drawn, employee salaries for everyone that assists you during your visits, electric, rent for the office, malpractice insurance, etc etc. Especially a small, independent practice. Nothing is free. At the end of the day it is insurance taking advantage of both the doctor and patient. A service is being provided and there should never be an expectation that it is free. Before you set up an appointment, the burden is on you to make sure you are going to an in network provider and to know what to expect as far as what your insurance plan is.
If it’s that serious, every doctor’s office receptionist should explain this when they’re collecting your insurance info during registration. During an emergency room visit the only concern you have is whether you’re going to leave feeling well better than you came. Not whether you have your copay readily available after your visit. What sense is that regardless of what you agreed to with your insurance company…your pain or sickness is not bound by a contract and sure doesn’t care if you haven’t gotten paid yet.
Yes, we pay other companies for their bill. But they are regulated ,We can ask for a refund if they fail to do the job ,we hire them for ,We can take them to court and,sue ,to demand the work is preformed correctly , But our only recourse for Doctor bills Is to prove negligence in treatment If we are harmed .a long process , Has a doctor ever had to return a co pay ,when we are not helped but have to see someone else for help ???..Along process
Big deal. Many doctors waive Co-Pays. No need to be greedy
It is not about greed. Doctors who routinely waive copays are in violation of federal anti-kickback laws and their insurance company contracts. It is a legal issue. They can be prosecuted for doing this.
By not doing so, they are violating their contracts with the insurance and federal laws. It is a violation of Federal Anti-Kickback laws (look it up!). Greed has absolutely nothing to do with collecting co-pays, it is an activity that all offices wishes they could avoid dealing with. Yes, it is a big deal when a doctor violates both federal laws and contractual agreements.
It is so odd to me that expecting people to adhere to the contractual obligations they entered into is ‘greedy’. Is it greedy when any other provider reasonably expects the payments you signed a contract stating you’d provide? Can I solely give a deposit to my contractor and when work is done complain that he/she is being greedy for expecting the remainder of the payment as promised?
When did adults find it so easy to shrug off their responsibilities?
Agree!
When heath care is free in just about every country in the world and you are living in totalitarian police state USA.
It is also important that office staff check patients insurance plans.Some policy do not require a copay once your deductible and maximum out pocket have been met.