Can a Doctor Waive a Patient Copay | Medical Practice Offices Need to Know

If you are participating and contracted with the insurance payers, you cannot legally waive a copayment because your contract (which is a legal document/agreement) is clearly stating and you agree that you need to collect the copay at the time of service or something like that.

See, you have a contracted rate with the insurance right? And so this is how it works:

Can a Doctor Waive a Patient Copay, Medical Practice Offices Need to Know

For Example:

If for that visit, CPT  Code 99213, your contracted rate with insurance payer is $77.89 and on that particular claim:

  • They allow $77.89;
  • Paid you $62.89
  • Applied $15.00 towards the patient’s copay

==> $62.89 (insurance payment) + $15.00 (Copayment of the patient) = YOUR AGREED CONTRACTED AMOUNT OF $77.89

Now, if you did not collect the copay for a processed claim (see above scenario); the contracted/allowed should have been $62.89 and NOT $77.89 – make sense?

And besides that. if you don’t collect the copay, you are losing money!


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This is the reason you cannot waive the copayment because it is part of your agreed and contracted rate with the insurance payer.

I have always advised my clients to collect the Copayment at the time of service, this will also help your daily cash flow.

Strategies on How to Effectively Collect Copayments:

  • When they call for appointment, as a courtesy let them know what their benefits are including their copayments;
  • When you call the patient to confirm an appointment, remind them that they have a copay for tomorrow’s visit;
  • Accept  Credit Cards and Debits Cards (avoid personal checks if possible);
  • If they forgot their purse and don’t have their check, offer credit card payment method or direct them to a nearest ATM Machine in the area
  • For stubborn patients, just nicely tell them you are contracted with their insurance company and your contract says you have to collect copays at the time of service;
  • Advise the patient to call their insurance if they still have issue with you collecting their copayment at the time of service


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Author: Pinky Maniri

Ms. Pinky, as she is fondly called - is a Reputable Professional Consultant and Expert in Practice Administration, Medical Billing, Coding, Health Information Technology, Insurance Credentialing and Compliance for Physician Offices. Well-educated with a Degree in Computer Systems Engineering and a background in Clinical Nursing and Small Business Management. Her professional mission is to make sure her clients/physicians maximize reimbursement while they remain compliant with the current rules, changes, guidelines and policies. Read More About Ms. Pinky here and See what Other's say about her Expertise Testimonials

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