"FORGIVE" YOUR CO-PAYMENT? by Dr. Josephine-Liezl Cueto, Ophthalmologist at Lakeshore Eye Care Professionals in Mequon & Saukville, Wisconsin
At the beginning of every year we get calls requesting that we "forgive" insurance co-payments. Some ask nicely, others are pretty insistent. Just to save our billing staff from another call on this subject, let me explain what co-payments are and how they function as part of your health insurance plan.
Co-payments are designed to share the cost of the visit with the patient. Every time co-payments go up, the amount paid to the doctor directly by the insurance company goes down.
If we 'forgive" a co-payment, it is actually insurance fraud. We have contracts with most major insurance companies stating what our compensation will be for specific examinations, testing and surgical procedures. If the patient is required to pay 20% of that or a certain dollar amount and we "forgive' it, there are several consequences.
First, we are not receiving that portion of our fees that the co-payment represents. Second, the fraud part is because the insurance company assumes the co-payment was made so reduces the patient's remaining deductible for the rest of the year. Third, if this activity is reported to the insurance company we are essentially stating that our fees are less than the contracted amount. This allows the insurance company to reduce our payments in the future for other patient's visits.
So as much as we would like to "forgive and forget", it is not so simple!
Dr. Cueto is a Physician and Surgeon (Ophthalmologist) specializing in medical and surgical eye care. She practices at Lakeshore Eye Care Professionals in Mequon and Saukville, Wisconsin.
For more eye care information or to schedule an appointment call 262-241-1919.
Visit www.Lakeshorevision.com for more eye care information and to learn more about Lakeshore Eye Care and Dr. Cueto.