Waiving Copayments

Physician's Money DigestMarch15 2004
Volume 11
Issue 5

One of managed care's primary cost-controlcurbs on the use of medicalservices is the copayment. Patientsare asked to pay a certain amount out ofpocket for each office visit or physician service,and the payments are even higher ifthe patient goes to a doctor who is outsidethe managed care network. According to a reportby the Kaiser Family Foundation, employees can pay asmuch as 30% of any charges for visits to out-of-networkdoctors. Now, there's growing evidence thatmany out-of-network doctors are not collecting copaymentsfrom their patients.

The reasons are diverse, according to health careeconomists. One is patient recruitment—a physicianmay acquire a patient who would otherwise chooseone of the managed care plan's in-network doctors.

Another is the desire to help those who otherwisemight not be able to afford the careprovided. Still another reason is to avoidthe paperwork and other administrativehassles involved in collecting and accountingfor the copayments.


The economic loss of not collectingthe copayment is often offset by the higher fees thatout-of-network doctors can charge, compared withwhat the managed care plan would pay if they were onits preferred provider list. Although doctors areincreasingly ignoring the copayment, they generallyask the patient to pay any deductible amount calledfor under their health insurance, which often can runto $2000 or more. Experts caution that waivingcopayments is a violation of the rules under the government'sMedicare and Medicaid programs.

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