Copay Clarification

October 1, 2005

Can I give patients discounts on their copays? For example, some of my patients now have copays exceeding $40. I’d like to charge them less. Can I take $20 instead? Also, can I give close friends the courtesy of waiving their copay?

Question: Can I give patients discounts on their copays? For example, some of my patients now have copays exceeding $40. I'd like to charge them less. Can I take $20 instead? Also, can I give close friends the courtesy of waiving their copay?

Answer: No and no.

Your commercial payer contracts oblige you to collect the copay the payer sets; they expect you to collect it all. It is out of your hands. Keep in mind that your patients and friends agreed to that copay when they signed their agreement to use that managed-care company.

That said, Medicare has stated that in very specific situations with truly indigent patients, physicians may waive Medicare copays. You should have written policies regarding when you are willing to discount these. Keep in mind, however, that you can't do it just to be nice to patients or family. It's for very poor patients only.