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  1. #1
    vikasintl is offline Member
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    Question Is it illegal for medical practioners to waive copay

    WA state

    Is it illegal for medical practitioners to waive coinsurance/ copay ?

    I think in some circumstances they can waive patients' coinsurance / copay ..may I know in what circumstances they can waive this legally?
  2. #2
    ecmst12 is offline Senior Member
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    In most cases it is frowned upon by insurance companies, they need to at least make an attempt to collect it. If the provider has a hardship program, and the patient applies for it and is approved, they may be able to waive the copay without issues.
  3. #3
    lealea1005 is offline Senior Member
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    Quote Originally Posted by vikasintl View Post
    WA state

    Is it illegal for medical practitioners to waive coinsurance/ copay ?

    I think in some circumstances they can waive patients' coinsurance / copay ..may I know in what circumstances they can waive this legally?
    Government insurance like Medicare & Medicad require Physcians to attempt collections of co-pays/co-insurances/deductibles. The Physician must be able to prove s/he attempted collections.

    Other insurance companes may contracturally obligate their providers to attempt collection of co-pays/co-insurances/deductibles.
  4. #4
    vikasintl is offline Member
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    Question so attempt is enough??

    So as long as they can show they tried like one or two phone calls and a mail letter...its enough correct?
    or what kind of attempt they should have made?
  5. #5
    tranquility is offline Senior Member
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    What is your real question? What happened?
  6. #6
    lealea1005 is offline Senior Member
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    Quote Originally Posted by vikasintl View Post
    So as long as they can show they tried like one or two phone calls and a mail letter...its enough correct?
    or what kind of attempt they should have made?
    Normally, a provide sends a bill because they expect to be paid for their services.

    Please answer tranquility's question.
  7. #7
    ecmst12 is offline Senior Member
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    Are you the provider doing the billing or are you the patient? If you are the patient, you should not be expecting your doctor to give up on collecting your copays - they can and very likely will pursue collections all the way up to a lawsuit. If you are in need of financial assistance, you need to see if you can work something out with the office, if they're willing, otherwise you need to find a way to pay the balance or the office may very well stop treating you.
  8. #8
    xylene is offline Senior Member
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    If a doctor wants to eat your copay, that is totally legal.
  9. #9
    vikasintl is offline Member
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    I asked provider before visit about waiving copay...

    Quote Originally Posted by tranquility View Post
    What is your real question? What happened?
    I asked one of the providers if you can waive copay as copay only will be about $800 ...but the provider office said its illegal...so I was wondering if this is their excuse or they are real?
  10. #10
    cbg
    cbg is offline Senior Member
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    There's no way on earth a copay is $800. Are you sure you don't mean coinsurance?
    Two things I am tired of typing: 1.) A wrongful termination does not mean that you were fired for something you didn't do; it means that you were fired for a reason prohibited by law. 2.) The above answer, whatever it is, assumes that no legally binding contract or CBA expressly says otherwise. If it does, the terms of the contract apply.
  11. #11
    vikasintl is offline Member
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    yeah I meant coinsurance and not copay

    Quote Originally Posted by cbg View Post
    There's no way on earth a copay is $800. Are you sure you don't mean coinsurance?
    sorry yeah I meant coinsurance...
  12. #12
    lealea1005 is offline Senior Member
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    Quote Originally Posted by vikasintl View Post
    I asked one of the providers if you can waive copay as copay only will be about $800 ...but the provider office said its illegal...so I was wondering if this is their excuse or they are real?

    "only will be about $800"...you're kidding, right? I'm sure you like to be paid for your work...well, so do Physicians (and other providers).


    Quote by:xylene
    If a doctor wants to eat your copay, that is totally legal.
    As I said earlier...not with Medicare or Medicaid.... and most private insurance contracts require provable collection attempts.
    Last edited by lealea1005; 01-04-2012 at 06:00 AM. Reason: delete snark..too early in the morning ;)
  13. #13
    Ohiogal is offline Senior Member
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    Quote Originally Posted by vikasintl View Post
    sorry yeah I meant coinsurance...
    Do you work for free? Or should I guess that you get through life without working and take every benefit known because you are "owed" that?
    Parents should remember 3 things: Love your kids more than you hate your ex; when you have children the relationship with the other parent is until death; your children determine what type of nursing home you end up in.
    Nothing stated by me should be taken as giving you legal advice or forming an attorney/client relationship.

    Attorney-GAL in Ohio.

    I've removed the knife from my back, polished it, and will one day return it -- long after you think I have forgotten.
  14. #14
    cbg
    cbg is offline Senior Member
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    Waiving a copay and waiving a coinsurance are two entirely different things.

    Completely setting aside the issue of legality, it's one thing to waive a $15 copay. It's entirely another to waive an $800 coinsurance. What makes you think that's such a small amount? The doctor has bills to pay too; they're not all rich.
    Two things I am tired of typing: 1.) A wrongful termination does not mean that you were fired for something you didn't do; it means that you were fired for a reason prohibited by law. 2.) The above answer, whatever it is, assumes that no legally binding contract or CBA expressly says otherwise. If it does, the terms of the contract apply.
  15. #15
    ecmst12 is offline Senior Member
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    Well for your purposes it doesn't matter whether it's an excuse or the truth, they're not going to waive your coinsurance. Set up a payment plan.

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