Doctor co-pays

[moneymaker]

What is a co-pay really. Does everyone pay it? I know I’ve not paid it on ocassion and I get the same services, the same bill. Pretty much it’s a shake down fee. Hence forward I’m going to refuse to pay it. Just say to the receptionist put it on the bill, then you will never see it again.

[spdrun]

It’s basically a per-visit deductible. If you don’t pay it, you’re not hurting the insurance co; you’re hurting your doctor and his employees.

(Mine happens to be a decent guy, so why would I want to cheat him?)

[UCGal]

I’m pretty sure Kaiser Permanente will bill you, and hound you if you don’t pay at time of service.

It’s part of the negotiated rate for group insurance. My sister and I both have Kaiser. She has a $10 copay, mine is $20. Because they premiums and copays were negotiated by different employers.

I guess you could not pay it – but they could come after you for it. Perhaps your doctor decided the cost to bill is more than the copay… but if enough people do it – they’ll come after you.

Just curious – do you pay your deductible if you’re in a car accident and get your car repaired? Or is that optional also? Do you pay the full ask when you get a haircut – or do you pay a lesser amount and hope they don’t mind too much?

[earlyretirement]

[quote=UCGal]I’m pretty sure Kaiser Permanente will bill you, and hound you if you don’t pay at time of service.

It’s part of the negotiated rate for group insurance. My sister and I both have Kaiser. She has a $10 copay, mine is $20. Because they premiums and copays were negotiated by different employers.

I guess you could not pay it – but they could come after you for it. Perhaps your doctor decided the cost to bill is more than the copay… but if enough people do it – they’ll come after you.

Just curious – do you pay your deductible if you’re in a car accident and get your car repaired? Or is that optional also? Do you pay the full ask when you get a haircut – or do you pay a lesser amount and hope they don’t mind too much?[/quote]

Just not pay it? That’s cute.

Places like Kaiser you can’t even see the doctor until you have paid the fee before the visit. When you signed up for the health plan you agreed to certain fees via a fee schedule. Different types of visits have different co-pays.

Visits for specialists cost more than visits for primary care, etc. MRI or Chest X-ray might have a higher cost.

I have Kaiser Permanente and so far really happy with them. “Shake down fee”. Hmm…. maybe next week when I have a procedure done I’ll tell them I don’t want to pay my co-pay and see what happens. LOL.

[moneymaker]

I’m glad I don’t have Kaiser. So seems like doctors don’t make enough money so they need a co-pay, or is it just mutually agreed between doctors and insurance companies that it is a way to improve their bottom line. I’m not saying other companies don’t gouge similarly, and I know it’s not much compared to the $400-$500 charge for that 15 minute visit, but where is the accounting? Sounds like Kaiser is on the ball, maybe because they control everything from end to end, I’m just saying I don’t think your average doctor is going to turn you down because they are not getting their co-pay, like everything in life I believe it is negotiable. Just like the insurance deductible analogy it is to keep claims down.

[ocrenter]

insurance companies/health plans make nothing from the co-pay. they would rather you stay home then to collect the co-pay.

it’s just a way to try to manage “overusers” of the system.

[all]

At Scripps they often don’t collect it upfront, they bill you instead.

[all]

[quote=moneymaker]I’m glad I don’t have Kaiser. So seems like doctors don’t make enough money so they need a co-pay, or is it just mutually agreed between doctors and insurance companies that it is a way to improve their bottom line. I’m not saying other companies don’t gouge similarly, and I know it’s not much compared to the $400-$500 charge for that 15 minute visit, but where is the accounting? Sounds like Kaiser is on the ball, maybe because they control everything from end to end, I’m just saying I don’t think your average doctor is going to turn you down because they are not getting their co-pay, like everything in life I believe it is negotiable. Just like the insurance deductible analogy it is to keep claims down.[/quote]

The co-pay is factored in your monthly premium. You can get $0 copay (a friend of mine works for the federal government and he and his family have that kind of plan) and pay higher monthly premium, or pay $50 co-pay and have lower premium.
My company covers the cost of premium (for the entire family), but my co-pay went up from $10 to $50 over the last 10 years.

[jimmyle]

My PPO insurance doesn’t have copay. Insurance pays everything upto $2400/family per year and then from $2400 to $5000 we pay everything. And then insurance pays 90% after $5000. Maximum out of pocket per family is $6000 per year.

[Coronita]

dupe.

[Coronita]

I have a running tab on UCSD hospital and UCSD Medical Group and Cedars Sinai Medical versus Cedars Hosiptal… (two seperate bills between facility charges versus physician charges)…

The standard practice is that if you don’t pay, it goes onto your account, and your medical record number is linked to your SSN.

I found out you can have all your deductibles,copays,etc your responsible for to be outstanding for about 6 months without calling them before they send you a notice telling you that if you don’t pay, they will send you to collections. And then, it’s a matter of calling them, giving them your CC#….

If i go see a doctor, in either one, I just tell them to put the copays on my account.

Generally, they never forget to bill you.

Often times, things get a little complicated because the billing is wacked because payments from insurance CO’s sometimes take time..

Also, my flex spending account is automatically linked, so when the medical group sends a bill to the insurance company, the insurnace company pays their portion, and then pays the rest of of the remainder of the flex account, until I run out.

Copays are around (per visit)

$15 for general doctor
$30 for specialist
$45 for urgent care
$100 for ER…

Last year it was about $15 for general doctor, and $30 for everything else…

Lol…

[spdrun]

Or sometimes, they do forget or at least are very slow to pay. A year ago, I had some lab work done which insurance didn’t pay for. They said they’d send me an invoice and so far never have.

I’m certainly not going to rush them — they have my address and phone #, and they’ll send it when they’re good and ready, I guess.

[no_such_reality]

I’ve found copays highly varied depending on the doctor practice and your insurance. Kaiser is very strict. With HMOs, the Doctors also tend to be more strict. With PPOs, the Doctors offices are a little more careless with collecting or billing.

Other specialty practices will vary depending on the organization level of the office. The larger the practice the more likely to collect.

Finally, the larger the copay, the more likely the office is to collect.

Mid-year the company I work for switched their prescription coverage to a new provider. Tier 1 copay $10, Tier 2 copay $20, Tier 3 copay 50%. Basically any brand name falls into Tier 3 now.

[ocrenter]

[quote=no_such_reality]I’ve found copays highly varied depending on the doctor practice and your insurance. Kaiser is very strict. With HMOs, the Doctors also tend to be more strict. With PPOs, the Doctors offices are a little more careless with collecting or billing.

Other specialty practices will vary depending on the organization level of the office. The larger the practice the more likely to collect.

Finally, the larger the copay, the more likely the office is to collect.

Mid-year the company I work for switched their prescription coverage to a new provider. Tier 1 copay $10, Tier 2 copay $20, Tier 3 copay 50%. Basically any brand name falls into Tier 3 now.[/quote]

the priority of the PPO provider is not the copay from the patient. the priority is maximizing the billing of the insurance company. the patient is just a tool for the PPO provider to use to justify maximum billing. therefore, giving breaks to the patient (including allowing the co-pay to slide) so the patient can stay with the PPO provider and keep coming back, is reasonable.

the HMO/Kaiser provider can’t maximize billing with procedures and tests. Nor is that the primary focus of the biller. So copay enforcement is stricter.

put it to you this way, PPO provider would want the patient to come back everyday if possible. HMO provider would want the patient to never show up.

[njtosd]

[quote=ocrenter]

it’s just a way to try to manage “overusers” of the system.[/quote]

Yup. If there was no cost to going to the doctor, people would be there everyday.

[Author]

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