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Patients cannot “Consciously Uncouple” or “Tenderly Undo” their Copayments with Doctors

Patients cannot “Consciously Uncouple” or “Tenderly Undo” their Copayments with Doctors

July 3, 2014



Percentage of Americans who can’t explain what a deductible is. 

Source: USC Center for Economic and Social Research

Today the MarketWatch WSJ Blog states:  Should you Negotiate Your Copayments?

The very short and legal answer is NO!  At least not as Quentin Fottrell is suggesting in the article.

People have a motivation to negotiate: Some patients feel even sicker after they go to the doctor’s office and hear the cost.  One answer: Start negotiating the bill with your doctor before services are performed or, better yet, before your visit, or offer to pay it all in cash. More people are bartering as they might at a farmer’s market, a process that’s made easier when the copay is a percentage of the final bill, says Dave Osterndorf, chief actuary of health exchanges for Towers Watson. “You’re trying to negotiate the amount you’re responsible for,” he says. “It’s one of the more poorly understood elements of health care,” he says. “Everybody has the right to go to a health care provider and ask to pay less.” Doctors and hospitals may be willing to barter over the cost of a service, Osterndorf adds, particularly if the patient says he or she is at risk of going into debt.

Not only is this story irresponsible it’s illegal.  The copayment is a contract between the patient and the insurance company.  If an office decides to not accept a copayment or alter the total cost of the copayment not only can the patient become immediately uninsured, the provider and ALL of their patients under that insurance carrier risk losing coverage at that facility.  Having consulting for many physician’s offices even staff were often confused and would put “hardship not collecting copayment.”

While the compassion is both commendable and understandable  it is not legal cause to change a contract between the patient and their insurance provider.  And I’ve heard it all:  “The doctor doesn’t need another fancy car so one missing copayment isn’t going to hurt,” said one informed employee.  One patient even went on to have an expensive surgery and the insurance company decided to back out the entire claim because a $15 copayment wasn’t taken at the time of the first appointment.

Don’t give insurance companies a reason to drop you or your doctor-they look for reasons to not pay.  There’s a reason most insurance companies still send paper claims and aren’t done electronically-some statistics claim that one in three claims will not be refiled which means the practices doesn’t get the money and insurance company gets to keep the money.

And from the comments section on from the MarketWatch article (weird my comment is no longer present).

MarketWatch Negotiating Copayments

MarketWatch 2

And now it’s back…

Usually HR Departments of a company will negotiate the health insurance contracts which include copayments along with if the plan will be an HMO (need prior auth to see specialist) or PPO can usually go to any doctor directly.  So as a patient and you’d like to “consciously uncouple” or “tendly undo” your copayent please don’t take it out on the office staff or the doctor.

And if you’d like to learn more about insurance healthcare terms:  healthcare.gov/glossary

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