Q&A: Problems with collecting copays

February 20, 2009

Patients need to understand their financial responsibilities, even if it means adding another layer of responsibility for your scheduling office.

Q: We perform colonoscopy screenings and flexible sigmoidoscopies in our ambulatory surgery center. We are having difficulty collecting the 25 percent co-insurance amounts from our Medicare beneficiaries. They argue that the co-insurance amount is 20 percent. Educating them and collecting the coinsurance has become tremendously time-consuming. How can we best address this issue? Can we adjust off the other 5 percent to keep them happy?

A: The answer to the last question is no, unless there is some demonstrated financial need. You are obligated to bill patients their portion of the approved amount for most insurance contracts. Not doing so could be interpreted as fraud (billing the patient one amount and the insurer another). The best solution is to make sure patients understand their financial responsibility at the time the procedure is scheduled. This may mean adding a step to your scheduling process, where someone from billing explains the financial responsibility to the patient and makes arrangements for the payment, preferably up front.