Understanding Your Insurance Copay
One of the most common questions, or to be honest, complaints I get in my podiatry practice involves patients paying their office copayment (copay). Patients argue with our reception staff, billing staff, the medical assistants, the physicians, and pretty much anyone that will listen about being charged a copay each time they are seen at our office. Many patients believe that we set their copayment amount, and it is our office that requires that they pay it. This seems to be a very widespread misunderstanding, so I thought a blog entry might help clear this up.
First and foremost to the understanding of copays is to know that your doctor’s office has very little to do with your copay. Wikipedia defines an insurance copay as, “ a payment defined in the insurance policy and paid by the insured person each time a medical service is accessed.” In other words, your copay is an amount of money set by your insurance company (not your doctor’s office). When you enter into a contract with your insurance company you agree to pay this copay amount each time a medical service is rendered. This amount is often printed on your insurance card. A lot of times a primary care physician (like your family doctor or pediatrician) will have a lower copay amount than a specialist like me (a podiatrist), or a heart specialist, ear nose and throat specialist, etc. Insurances also usually have separate copays for office visits, inpatient hospital visits, outpatient surgery, emergency room visits, and prescription drugs.
At Advanced Foot and Ankle Care, surgery is a large part of our practice, and patients often have questions about their copays for scheduled post-op follow up visits. Some insurance policies do not require a copay during the post-operative follow up time (called the global period) since an office visit is usually not charged during this time. Some insurance policies do require a copay during this time if services other than a visit are performed (x-rays are taken, a cast is put on, or you are seen for a condition separate from the surgical follow up). This will often vary by specific insurance plan. It is your responsibility, not the office’s to check on the specifics of your plan.
This brings us to another popular question. If you already pay a premium to your insurance company every month, why do they even require copays? Insurance companies use copays to make you responsible for a small portion of your healthcare expenses. They want you to know that your medical care is not free. Having to pay a copay may discourage people from running to the doctor for every trivial condition they may have (i.e. sniffles or the common cold, for which there is no cure). So basically copays save insurance companies a substantial bit of money. On the other hand, people with multiple serious health conditions, especially the elderly, may need to see many different doctors a week, but do not go to these appointments because they cannot afford the multiple copays.
So, what happens if you do not have the money for your copay? Most offices ask that if your insurance has a copay, you pay before you are seen. This is not unreasonable. If you are there, obviously we expect that services will be rendered. If a patient objects to this, and sometimes they do, we do allow them to pay upon check out after their appointment. In the end the amount is the same whether you pay before or after your appointment. If a patient refuses to pay their copay one of a couple of things may happen. You could be refused service, or if you are a patient in good standing (you have never had late payments, do not have an outstanding balance, and do not frequently miss appointments) then you may be billed for the copayment amount. If you have complaints or questions about your copay our office staff, specifically the billing staff, will do their best to answer these questions in our Sidney, OH office, but the most appropriate place to find answers is with your insurance company.