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?

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4 thoughts on “Yes, You Must Pay Your Copay

    1. 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.

    2. 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.

  1. 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.

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