Can I Waive a Patient's Co-Pay?

Articles / Publications

Reprinted with Permission from the Birmingham Medical News.

I am occasionally asked by providers whether or not they can waive a co-pay for a particular patient. There are many reasons providers wish to waive co-pays: financial hardship, professional courtesy, employee discounts, etc. All of these reasons are well justified and appropriately motivated. Further, all of these reasons would be appropriate for a client discount in almost any other industry (e.g., retail) except healthcare, which is one of the most, if not the most, highly regulated industries. Consequently, appropriate motivation is not always sufficient for giving "patient discounts" due to applicable legal restrictions. This article will focus on waiving co-pays for reasons related to financial hardship.

Federal regulations prevent the routine waiver of co-pays for Medicare and Medicaid patients. Similarly, other third-party payors may also contractually prohibit routinely waiving co-pays. Federal regulations, however, do allow the non-routine waiver of co-pays in situations of financial hardship as long as certain conditions are satisfied. The wavier may not be offered as part of any advertisement or solicitation, and the provider may only waive the co-pay after determining in good faith that the patient is in financial need. When looking at financial need, providers can examine a variety of factors, including cost of living, patient's income and assets, patient's family size, and the scope and extent of medical bills. There is some flexibility given to the provider in determining what constitutes a financial hardship. However, providers cannot consider the ability of the patient to generate business or referrals when making the determination. Eligibility for co-pay waivers should also not be based on race, age, creed, sex, religion, ancestry, marital status, disability, national origin, or any other legally protected category.

Download the full article, "Can I Waive a Patient's Co-Pay?" written by Kelli Carpenter Fleming.

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