Potential Consequences of Forgiving Copayments

Back in the day, before health insurance entered the market, patients negotiated directly with healthcare providers and paid what they could afford, often on a sliding scale. Deductibles, copayments, and coinsurance developed as a check against overutilization once insurance companies became responsible for the bill.  These days, many insurance companies are increasingly checking up on the collection of copayments, deductibles and coinsurance by asking for proof of payment collection.  And in certain instances, especially in times of financial hardships, some providers do indeed waive copayments for their patients (yet still bill the insurance companies for services).

With the upcoming changes in the industry, it’s especially important for providers to understand the rules regarding the waiver of copayments.  Providers should be aware that forgiveness or waiver of copayments may violate policies of some insurers, both public and private.  It’s especially important to note that routine waiver of copayments may constitute fraud.  With the ACA rollout expected to be in full swing by the next year, providers should make it a priority to not only update their financial policies, but also to place an emphasis on patient responsibility.

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