| Posted By |
Message |
| Pages: 1 [2] |
LoveDayLove
LIF Adult
Member since 2/11 1250 total posts
Name:
|
Re: Does anyone know if its illegal for a doctor to waive a copay???
My dad sells insurance claims and he says its insurance fraud. I get so aggravated when the doctor gets me in the office and then sends me to the hospital but she still has to charge.
|
Posted 8/14/11 5:59 PM  |
| |
|
Long Island Weddings
Long Island's Largest Bridal Resource |
lynnd126
LIF Adult
Member since 3/11 2630 total posts
Name:
|
Re: Does anyone know if its illegal for a doctor to waive a copay???
Posted by TaraHutch
geez, all this info is kinda worrying me. My chiropractor whom I love to pieces gives me a 'deal' for a year's worth unlimited and I just pay that up front, instead of paying co-pays for each visit. It is an unreal deal when I look at it and kinda worries me...can it come back to bite me in the butt?
IMO I think it's his problem and not yours- he's the one that could get bit.
|
| Posted 8/14/11 7:03 PM |
| |
|
mlny
blessed <3
Member since 10/09 2113 total posts
Name:
M
|
Re: Does anyone know if its illegal for a doctor to waive a copay???
Posted by missrock
Posted by mlny
I think it's pretty ballsy to even ask for a doctor to waive a copay. You're asking him to put his job at risk and then you get upset that he won't do it?
Thats why I asked this question....i didnt know it was insurance fraud. Did you read my original post...thats why i started the post i the first place. now I know so i will never ask again. So I dont think I was ballsy. But thanks for your two cents.
Thanks for all those answered my question...i appreciate it.
How could you not think it's ballsy to ask someone not to charge you? I'm pretty sure if a friend or family member even wanted to give a 'discount' of some sort, they should be the one to offer. But again, just my two cents. Glad you got the answer to your question.
|
| Posted 8/14/11 7:37 PM |
| |
|
dm24angel
Happiness
Member since 5/05 34581 total posts
Name:
Donna
|
Re: Does anyone know if its illegal for a doctor to waive a copay???
How is it insurance fraud?
I worked for insurance for years. Basically most dr's charge for lets say a basic office visit $65..and you have a $20 co pay. The insurance for arguements sake pays the $45.
The insurance has no clue if you ever paid your $20 co pay and honestly, they dont care. The co-pays dont affect the insurance company in any way. They are established as lowering the cost for individuals or for the company purchasing the insurance policy.
If the Dr. waives yoru co pay for you, it is coming out of his pocket. He doesnt get 'more' money from the insurance company b/c you didnt pay. That money for the copay comes off the top of the insurance claim as individual liability.
Many Dr's waive co pays. Mostly Chiro's and Physical therapists. When I was going to P/T..I had to go 3 x's a week at a $50 copay PER VISIT. I couldnt afford that!
There was signs all ove rthe front desk saying please talk to us if you need copay assistance etc.
I ended up paying for 3 visits a week $80.They took that loss .
|
| Posted 8/15/11 12:00 AM |
| |
|
WhatNow
Say Cheese!
Member since 1/06 8033 total posts
Name:
A (formerly WhatNow?)
|
Re: Does anyone know if its illegal for a doctor to waive a copay???
Sounds like BS to me! How would insurance even KNOW it was waved??
MY sister worked in a doctor office for years, she is no longer there but whenever I have to go in they NEVER charge me co-pay, as a curtesy to my sister!
Of course, the "oh, no, I can't wave it, it would be fraud" is an extremely convenient line!
|
| Posted 8/15/11 12:10 AM |
| |
|
sunnyplus3
:)
Member since 11/05 8749 total posts
Name:
|
Re: Does anyone know if its illegal for a doctor to waive a copay???
Posted by dm24angel
How is it insurance fraud?
I worked for insurance for years. Basically most dr's charge for lets say a basic office visit $65..and you have a $20 co pay. The insurance for arguements sake pays the $45.
The insurance has no clue if you ever paid your $20 co pay and honestly, they dont care. The co-pays dont affect the insurance company in any way. They are established as lowering the cost for individuals or for the company purchasing the insurance policy.
If the Dr. waives yoru co pay for you, it is coming out of his pocket. He doesnt get 'more' money from the insurance company b/c you didnt pay. That money for the copay comes off the top of the insurance claim as individual liability.
It absolutely IS fraud, even if you've had doctors that were willing to commit it. Its actually federal law, part of HIPPA.
Insurance companies do care because they don't want to pay most claims anyway ( more so in dentistry but in medicine as well). They could easily use that as an excuse to drop that doctor/PT/chiropractor as a provider OR pay less than they would usually pay.
It does happen all the time, but the OPs question was "is it illegal" and the answer to that question is YES.
Her brother in law could have paid the copay for her or he could have elected to not charge her or her insurance at all, but the fact is whether he's cheap or not- he didn't lie.
There are dentists and doctors serving time in jail or fighting to defend themselves right now over this very issue.
Dd you know that if a doctors mom has Medicare( just about all do) and they don't collect her copayment or submit to her part B that is fraud? The majority of doctors that have been convicted of this felony had medicare/Medicaid claim errors on their books.
|
| Posted 8/15/11 7:08 AM |
| |
|
Chai77
Brighter days ahead
Member since 4/07 7364 total posts
Name:
|
Re: Does anyone know if its illegal for a doctor to waive a copay???
Yes, it absolutely is insurance fraud to not collect copayment. There is a space on the billing form we send in to the insurance companies to report patient's payment, so they do (or should) know what the patient paid.
Patients don't need to worry, providers are responsible and can be held liable for not collecting copays.
|
| Posted 8/15/11 7:40 AM |
| |
|
DumpsterBaby
My compass when I'm lost
Member since 5/11 2210 total posts
Name:
My anchor when I get tossed
|
Re: Does anyone know if its illegal for a doctor to waive a copay???
It is insurance fraud to not collect a copay.
You are comparing apples to oranges by saying he's cheap and gives your kids clearance items. One has nothing to with the other. HIS JOB requires him to collect copays, and if he does not, it is his azz on the line, not yours. You sound like the cheap one for trying to get out of paying your copay.
|
| Posted 8/15/11 8:29 AM |
| |
|
|
|
Re: Does anyone know if its illegal for a doctor to waive a copay???
I don't think its illegal. Our explanation of benefits says Dr So and So May Bill you $25 (co-payment). it doesn't say he has to bill us. I've had co payments waived for long wait times etc.
|
| Posted 8/15/11 9:29 AM |
| |
|
tara73
carseat nerd
Member since 11/09 3669 total posts
Name:
Buttercup
|
Re: Does anyone know if its illegal for a doctor to waive a copay???
It's federal, part of Medicare/Medicaid law, it's been a law for at least 20 years, it's included as part of Federal anti kickback laws. It's also a clause in many private insurer contracts. There have also been lawsuits filed by insurers in which the routine waiver of copayments has been found to be fraud/false claims.
Here's a pretty decent and short explanation
http://www.hcpro.com/REV-46459-2477/Beware-of-waiving-copays-and-deductibles.html
Here's another article http://www.assetlawyer.com/wordpress/?p=451
Like I said before, they don't have to actually pursue collecting it, just attempt to.
|
| Posted 8/15/11 9:42 AM |
| |
|
tara73
carseat nerd
Member since 11/09 3669 total posts
Name:
Buttercup
|
Re: Does anyone know if its illegal for a doctor to waive a copay???
Posted by dm24angel
How is it insurance fraud?
I worked for insurance for years. Basically most dr's charge for lets say a basic office visit $65..and you have a $20 co pay. The insurance for arguements sake pays the $45.
The insurance has no clue if you ever paid your $20 co pay and honestly, they dont care. The co-pays dont affect the insurance company in any way. They are established as lowering the cost for individuals or for the company purchasing the insurance policy.
If the Dr. waives yoru co pay for you, it is coming out of his pocket. He doesnt get 'more' money from the insurance company b/c you didnt pay. That money for the copay comes off the top of the insurance claim as individual liability.
Many Dr's waive co pays. Mostly Chiro's and Physical therapists. When I was going to P/T..I had to go 3 x's a week at a $50 copay PER VISIT. I couldnt afford that!
There was signs all ove rthe front desk saying please talk to us if you need copay assistance etc.
I ended up paying for 3 visits a week $80.They took that loss .
False claims. Insurance fraud.
If they routinely bill the insurance 65 and waive the 20, it has been ruled by judges that the actual charge is 45 not 65.
|
| Posted 8/15/11 9:44 AM |
| |
|
PhyllisNJoe
My Box Is Broken
Member since 6/11 9145 total posts
Name:
Phyllis
|
Re: Does anyone know if its illegal for a doctor to waive a copay???
My Dr. used to waive it for me if I had to go back to him within a few days of my last visit. Like if I went there with a bad cold and he didn't think I'd need antibiotics and then 3 days later go in with a massive sinus infection. He'd go to the front and tell them not to charge me the co-pay.
|
| Posted 8/15/11 9:47 AM |
| |
|
missrock
Beautiful!!!!
Member since 5/06 3808 total posts
Name:
Jennifer
|
Re: Does anyone know if its illegal for a doctor to waive a copay???
Posted by DumpsterBaby
It is insurance fraud to not collect a copay.
You are comparing apples to oranges by saying he's cheap and gives your kids clearance items. One has nothing to with the other. HIS JOB requires him to collect copays, and if he does not, it is his azz on the line, not yours. You sound like the cheap one for trying to get out of paying your copay.
News flash, this is why I asked this question. Everyone is missing my point. I wasn’t sure if it was or not and I do question my BIL because of his cheap ways….hence why I came on this website to ask a simple question. I am by far cheap but I thought maybe he could have done a favor for me if it wasn’t illegal. I have no problem seeing another doctor.
When you experience someone like BIL you would probably react the same as I did.
I will say this once again….now I know the truth and will not ask him to do it again. As much as I cant stand him, im not that heartless for him to lose his license…im just not the biggest fan of his.
|
| Posted 8/15/11 12:07 PM |
| |
|
| Pages: 1 [2] |
