Here and there you may receive patient refusing to pay for the copay, deductible, or coinsurance, and the question is, what is the correct way to handle these requests?

Before you make your decision, it is important to be aware of your responsibilities as an in-network provider. Routinely waive patient's responsibility raises potential Federal Anti-Kickback Statute, Federal False Claims Act, and state law liability. It is a violation of your contract with an insurance company, and by violating your contract, you may be aware of possible consequences as:

  • The insurance demanding refund of any reimbursement paid;
  • The insurance revoke your contract (loss of patients and source of income);
  • Your office may be charged for fraud.

It is acceptable to waive the patient's responsibility in isolated cases, as per example, the patient is facing severe financial hardship (bankrupt), and if your office has a good reason for waiving a balance, records of all conversations with the patient should be kept. It may be a good idea to request the patient to provide a bankruptcy discharge letter. You should be able to provide evidence that a good faith effort was made to comply with the law and make exceptions only for specific reasons. Furthermore, healthcare providers should keep track of all payments collected from patient and any payment that was waived as evidence that the patient’s insurance responsibility is not routinely waived.

Make sure your staff is aware of the law, so next time that a patient requests to waive a charge, they will be equipped with a proper information of why it is your office's obligation to comply with the law collecting the amount assigned to the patient by the insurance.