What Are Copays

What is a co-pay?

A copay is the small amount you have to pay to access medical care according to your insurance contract. In some cases, it might be $5-15 but with some insurances, it would be a percentage of your bill (10% is common). This is supposed to provide a slight incentive for you to visit the doctor less and thereby avoid overuse of medical services. Medicare patients don't pay a copay "up front", but they are responsible for a small portion of the bill.

Why do I have to pay my copay?

When you sign up with an insurance carrier, you basically sign a contract which stipulates that you are obligated to pay your copay in certain instances. That usually means that you are required to pay a copay for all office visits, including follow-up examinations, outpatient surgical procedures done in our office, etc.

Why do you collect the copay instead of billing me like my last doctor?

It is much more efficient to collect the copay at the time of service. Otherwise it becomes an difficult to deal with administratively. It needs to be entered in the computer, bills must be mailed, and our billing person will need to track the account for payment, etc. Higher administrative costs in the office ultimately result in higher medical costs for the patient.

Why can't you just "write off" my copay?

There are several reasons why this is not a good idea. First, since your insurance "contract" stipulates that you must pay a copay, waiving this fee violates your contract. Second, when we sign up with your insurance company, we also sign a contract that says we will collect copayments as stipulated in the contract. Third, if the doctor gives you a discount by waiving your copay and then bills the insurance company without giving them the same "discount", it could be considered insurance fraud. Thus, many medical billing consultants say that if you waive the copay, you cannot bill the insurance company. This rule has effectively eliminated "professional courtesy" which existed when I was a kid. Doctors used to routinely treat each other and their families "for free", but since everyone is insured these days, everyone must pay a copay.

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Heartland Dermatology


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