Routine Waiver of Patient Copay Is Illegal

Q. To help build my patient base, can I offer a new patients a free initial consultation by waiving their copay?

A. No. You cannot do this. It is a violation of state law under the Insurance Code to intentionally charge two different prices for providing the same product or service when the higher price charged is based on the fact that an insurer will pay all or part of the price of the product or service.

For Medicare and Medicaid, federal law never allows waivers offered as part of any advertisement or solicitation. Many managed care plans also have rules against waiving copayments and deductibles, so review your managed care contracts.

TMA’s white paper, “Prompt Payment Discounts for Patients” (PDF) explains the legal issues involved in offering patient discounts.

 Looking for ways to enhance practice revenue? Correct billing and collections processes can help you improve cash flow, collections rates, and staff efficiency. Consider scheduling a Revenue Cycle Assessment from TMA Practice Consulting, or for a more comprehensive look at your business, an Operations Assessment. For more information, email TMA Practice Consulting or call (800) 523-8776.

NOTICE: The Texas Medical Association provides this information with the express understanding that 1) no attorney-client relationship exists, 2) neither TMA nor its attorneys are engaged in providing legal advice and 3) that the information is of a general character. This is not a substitute for the advice of an attorney. While every effort is made to ensure that content is complete, accurate and timely, TMA cannot guarantee the accuracy and totality of the information contained in this publication and assumes no legal responsibility for loss or damages resulting from the use of this content. You should not rely on this information when dealing with personal legal matters; rather legal advice from retained legal counsel should be sought.

Published March 12, 2013

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Last Updated On

June 23, 2016