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    Patient discounts the fine line between leniency and liability

    Patients are clamoring for discounts amid rising deductibles and copays, but doctors could pay a steep price for offering them in spite of their good intentions, experts warn. In addition to the obvious hit to revenue, discounting can present a legal minefield as payers increasingly challenge the practice.

    Geoffrey Booth, MD, offers discounts to patients in financial distress. Doing so is generally considered acceptable, but he has noticed payers scrutinizing any financial relief to make sure it is valid. 

    One patient, a man in his 60’s with an addiction disorder, has several medical problems Booth is treating along with the addiction, including pulmonary and cardiac issues. The patient is insured, but can’t afford his share of the costs, so Booth has reduced his professional fees for the addiction treatment and has been helping the patient find in-network care for his other health problems.

    “When I first began seeing him, I was shocked at the number of things he needed but hadn’t received, like an EKG and a cardiology exam,” says Booth, a Malibu, California, internist. The addiction itself played a role in his lack of treatment, but out-of-pocket costs also were a factor, he says. 

    Discounting fees for financially strapped patients may be laudable from a humanitarian standpoint, but practice and legal experts recommend sharpening up policies on charity care and adopting written guidelines for prompt-pay and other discounts.

     

    Cracking down

    “We all know there are times you will come across patients who can’t pay,” says Booth. “Insurers are making it clear it’s illegal to just continually waive copays and that if you do, they will come after you. It’s a pretty daunting thing, because we know as physicians we can’t just discount because we like the patient or we’ve had them for 20 years.”

    Last November, New York health and financial services regulators wrote to physicians in that state, reminding them of copayment rules. “A physician may understandably and rightly waive a copayment or coinsurance for an indigent patient, for example, or decide that prosecuting a patient for a copayment or coinsurance is not cost effective,” regulators say.

    Routinely waiving payments could constitute insurance fraud, however, as can billing an insurer for a waived patient’s obligation. Physicians found to be doing so “may be subject to professional misconduct penalties, including, but not limited to, revocation of his/her medical license,” the letter warns.

    State laws vary widely regarding patient discounts, so the New York letter is a general reminder to physicians in all states to check out their current statutes and make sure their discounting procedures are legal.

    Next: Calls for help with rising deductibles

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