"FORGIVE" YOUR CO-PAYMENT? by Dr. Martha Jay, 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 decrease usage of health care services by giving the patient some ownership of the cost of the visit. Often patients are given the option of lower premiums at the cost of higher co-payments. 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 amount for the rest of the year. Third, if reported to the insurance company then we are stating that our fees are less than the contracted amount so further payments are reduced.
So as much as we would like to "forgive and forget", it is not so simple!
Dr. Martha Jay is a Board Certified Ophthalmologist (Eye Physician Surgeon) who stared Lakeshore Eye Care Professionals in 1992 after completing her Ophthalmology training at Northwestern University in Chicago. She and her colleagues, Dr. Mark German and Dr. Josephine-Liezl Cueto, are proud to be providing the latest in medical and surgical eye care in an independent medical practice.
Specializing in small incision cataract surgery with premium lens implants; blade-free iLASIK Vision Correction; Glaucoma care; Macular degeneration treatment; dry eye options and much more.
Call 262-241-1919 for more information or appointments.
Visit www.LakeShoreVision.com to find our Eye Care Blog and sections on many common eye conditions.