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Patient Copays: To Bill or Not to Bill?


You can't order a coffee today and pay tomorrow, so don't let patients leave your medical practice without some kind of payment arrangement.

Imagine this scenario: A man walks into a coffeehouse and orders a large vanilla latte and a muffin. The barista immediately starts working on his coffee. The man tells the cashier, "I forgot my wallet. Can you just send me the bill for this?" The cashier looks at him with incredulous eyes.

Sound ridiculous? It happens all the time in my medical practice, especially for the dreaded copay.

Most patients are compliant with paying the copay cost. At the beginning of the new year, they usually seem to even know when their copay amount has changed. But we do have people that tell us just what was said in the above vignette, and more, including:

• "My husband/wife has the credit card or usually takes care of this."

• "My purse is in the car."

• "Can you just bill me?"


I think patients sometimes forget that we are a business and we have bills and payroll that we must pay. But according to each patient’s insurance company, patients have their own responsibilities, especially when it comes to copays.

The gradual phase-in of healthcare reform has caused a great deal of confusion over what type of visit has a copay and which doesn’t. Physical exams (well-child care) usually don’t have an out-of-pocket expense for the patient, but regular office visits and follow up appointments do have a copay associated with them. It’s easy for patients to get confused and possibly frustrated because they might not understand why one office visit will have an out-of-pocket fee while another (seemingly similar) visit does not.

So …what can be done?

We have instituted several changes that have helped. First, we ask for the copay at check-in before seeing the patient for those that have a copay. (Obviously, for those patients with an 80/20 plan or no insurance, the charge will vary depending on the level of service. This is handled later in the visit.)

If we must bill the copay, we tack on a $5 service charge to defray the labor cost involved in generating this bill and to encourage the patient to pay the copay up front in the future . Another tactic that has worked for us is to transfer any credit that may be on another family member’s account for the current day’s visit. Finally, for those patients who lack health insurance, we offer a discount if the bill is paid in cash on the same day of service. (After all, we are in pediatrics and I feel really bad about the kids without health insurance.)

Copays are a fraction of the total bill for an average office visit. Even so, these small amounts can really add up. Make sure your front desk is diligent about collecting these payments on the day of service.

And enjoy your latte!

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