The Health Care Financing Administration (otherwise know as HCFA) is the federal government
agency responsible for setting policy and overseeing the Medicare and Medicaid programs.
HCFA has mandated that physicians and other providers of health care MUST collect co-pays and
deductibles. This is enforced by the Office of the Inspector General (OIG).
Providers that do
not collect are subject to prosecution for fraudulent billing under federal law! Penalties include
a maximum fine of $25,000.00, five years in jail, or both!!! Make no mistake about this, there are
currently health care providers sitting in jail for violations. Private insurance companies can
also prosecute providers who fail to collect co-pays and deductibles.
The reasoning behind this is as follows. If your doctor waives your co-pay or deductible he or
she is in effect giving you a discount. Therefore if he is willing to "sell" his service to you
at a discount, he should also give a discount to the insurer. The second reason for this is that
the insurer's objective for requiring co-pays and deductibles is to cause you, the insured, to have
a share in the cost of your health care, thereby reducing unnecessary consumption of covered
services.
Finally, please consider that despite what we see in the movies, most physicians these days are
NOT "making millions". Granted most, although certainly not all, make a good living. Some
physicians we know are barely getting by and some have taken to teaching or other means to make
ends meet. None are making what they were accustomed to in the days before managed care.
Therefore, from a practical standpoint, the collection of co-pays and deductibles has, in many
cases, become a matter of survival. You have to consider that your doctor went to medical school
for many years, accumulating significant debt, before he or she made their first dollar.
In addition they work long, odd hours, often are on call, subject themselves to every infection
that "walks" into their office and must deal with aspects of the human body that would repulse
most of us.
If you would like to avoid co-pays and deductibles there are two
things you can do. One is to purchase supplemental insurance to cover such items. The second choice
applies only to those who are in serious financial difficulty. Your doctor can waive your co-pay
or deductible however YOU MUST speak to him and provide documentation of a distressed financial
condition.
For more information on this subject contact Medicare, HCFA, your insurance company or the
Office of the Inspector General.
Doctors
Billing Clerksm
Never forget!