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Fam Pract Manag. 1999;6(3):54

Discounting self-pay patients

Balance billing HMO patients

Practicing in a strip mall

Waiving a co-payment

  • Government-funded plans. Simply put, co-payments cannot be waived on any government-funded plans or programs such as Medicare, Medicaid, CHAMPUS or Medicare HMOs.

  • Commercially insured patients. If your practice participates with the patient's insurance company, waiving the co-payment is probably unacceptable under your contract with that insurance company. Look at the wording in your contract for clarification. If you receive approval from the insurance company to waive the co-payment for a patient or class of patients, get it in writing for your own protection.

    If you don't participate with the patient's insurance company, you can waive the co-payment. We advise that you notify the patient in advance of your nonparticipating status since the patient is likely to have more out-of-pocket cost.

  • Employees. Your employees should be treated as above — the same as your other patients. But their employment status adds a complication: Waiving co-payments for employees may present payroll tax and other employment law issues that should be discussed with your practice consultant, accountant or attorney.

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Copyright © 1999 by the American Academy of Family Physicians.

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