Writing off co-pays and deductibles

[Job_Hunting]

What is the name of your state? IL

Is is legal in the State of IL for a health care provider to regularly write off patient deductibles and co-shares? Both with non-contracted insurance companies and contracted.
Thanks to anyone who might know--

[averad]

Yes it is legal for a provider (Dr etc.) to adjust the ammount they bill the patient.

Why?

[lili2000]

Really, why? It states in the contract between provider and insurance and between patient and insurance that the patient is responsible for any copays, coinsurance portions and deductibles. Non-par providers maybe different, but why bother with a contract if you are not going to honor it?

[averad]

Originally Posted by lili2000

Really, why? It states in the contract between provider and insurance and between patient and insurance that the patient is responsible for any copays, coinsurance portions and deductibles. Non-par providers maybe different, but why bother with a contract if you are not going to honor it?

The provider is just paying the copayments and deductible and thats perfectly legal.

The real question is who would complain?

The Insurance carrier? No they are getting their payments
The member? No they are not paying co-payments or deductible
The medical professional? Now thats just silly

[lili2000]

But the provider needs to do it for everybody right? Otherwise he would be discriminating against those who have paid their portion.

[averad]

Originally Posted by lili2000

But the provider needs to do it for everybody right? Otherwise he would be discriminating against those who have paid their portion.

The other patients would need to complain and prove it, however the OP did not state this was a special thing.

I can't read minds, I can only work with what I am given.

[lili2000]

I just received some government regulations stuff or HIPAA regulations that warns providers not to do such thing and billing companies that are instructed by the dr can get in trouble....i haven't had the time to really look through it (i just got it today)....that's why i am trying to understand the legalities behind this...

[averad]

Originally Posted by lili2000

I just received some government regulations stuff or HIPAA regulations that warns providers not to do such thing and billing companies that are instructed by the dr can get in trouble....i haven't had the time to really look through it (i just got it today)....that's why i am trying to understand the legalities behind this...

I cannot comment on documentation you possess, if you have an electronic copy I would be more then happy to look at it.

[lili2000]

you are awesome! i'll see if i can somehow send it, even if not, thanks for your help!!

[MellowCat]

If a provider is contracted with a carrier, then they are not allowed by contract to write off copays, coinsurance or deductibles at will. The only exception is if they provide these write-offs for other professionals and they have a consistent, across-the-board policy. Medicare in particular frowns on physicians writing off copays and states that providers can be fined in the tens of thousands of dollars, or even go to jail, if caught doing this, especially on a regular basis. Something to do with an "Anti-trust Kickback Statute" or some such.

Other carriers say that if they catch you doing this, they will start paying you based upon the amount you are writing off (the amount you are actually charging the patient), instead of the contracted fee schedule because the way they see it, if you are accepting less, then that's what you will get from the carrier.

[averad]

Originally Posted by MellowCat

If a provider is contracted with a carrier, then they are not allowed by contract to write off copays, coinsurance or deductibles at will. The only exception is if they provide these write-offs for other professionals and they have a consistent, across-the-board policy. Medicare in particular frowns on physicians writing off copays and states that providers can be fined in the tens of thousands of dollars, or even go to jail, if caught doing this, especially on a regular basis. Something to do with an "Anti-trust Kickback Statute" or some such.

Other carriers say that if they catch you doing this, they will start paying you based upon the amount you are writing off (the amount you are actually charging the patient), instead of the contracted fee schedule because the way they see it, if you are accepting less, then that's what you will get from the carrier.

The carrier can do what they like with their contracted providers. The original question is it illegal and the answer still remains no, unless you or someone can produce a law that states other wise.

Medicare is a completly seperate beast.

[ecmst12]

The way I've heard it explained is that it's considered fraudulent billing to bill insurance for something if you wouldn't charge the patient for it. So, my dad is a dentist, he treats me for free, if I were to have dental insurance, it would be fraudulent for him to bill them because he'd be treating me for free if I didn't have insurance. So if the doctor is just going to write off the copay, that makes it seem as though they'd write off the whole amount if the patient didn't have insurance, hence the disapproval of the insurance companies.

My current insurance policy also has a specific exclusion listed for "charges billed solely because the patient has insurance" or some similar wording to that.

[averad]

Originally Posted by ecmst12

The way I've heard it explained is that it's considered fraudulent billing to bill insurance for something if you wouldn't charge the patient for it. So, my dad is a dentist, he treats me for free, if I were to have dental insurance, it would be fraudulent for him to bill them because he'd be treating me for free if I didn't have insurance. So if the doctor is just going to write off the copay, that makes it seem as though they'd write off the whole amount if the patient didn't have insurance, hence the disapproval of the insurance companies.

My current insurance policy also has a specific exclusion listed for "charges billed solely because the patient has insurance" or some similar wording to that.

Family cannot treat family and receive payment from an Insurance Carrier its 99% of the time a contract exclusion (and also completely different from a provider writing off co-payments).

Chiropractors, Acupuncturists & Naturopaths all commonly have an insurance and non insurance rate. These providers are often considered non covered on insurance policies so they want to make non insured or non covered people able to afford the services. However in these cases the providers are rarely contracted so this isn’t a true example.

Clinics however are a true example. They offer free or low priced services to non insured or high deductible members. Insured members can also utilize the clinics and the clinics will bill the insurance at full rate. The same goes for Planned Parenthood.

[Job_Hunting]

Hi,

I am the original poster--

I do work for a chiropractic office, and as their financial officer I wanted to be sure that I am engaged in legal practices; hence the question.

It is a common practice for us to write off the patients portion accept their agreed upon co-pay which is only charged weekly. And it is done for everyone, except Medicare patients, as we are not permitted.

Thanks--