A New Year for Collecting Deductibles and Coinsurance Payments

By: Stephen Siegel

January 1 was the first day of the New Year. Many events and efforts begin on the first day of the year, including the start of a new insurance claims cycle – which brings with it new deductible and coinsurance/copayment obligations.

Some physicians, healthcare professionals and providers (collectively referred to as “Providers”) think waiving patients’ coinsurance and/or deductible obligations is a good business development strategy. In fact, routinely waiving patients’ coinsurance and/or deductible obligations and forgoing monies the practice is otherwise entitled to receive may have significant financial and legal consequences.

Most private payers require their insureds or enrollees to be responsible for an annual deductible and copayments for health care items and services. Requiring insureds/enrollees assume responsibility for a portion of the cost of their health care items and services may make them reluctant to “run to the doctor” without a real need. In addition, paying a portion of Providers’ charges mitigates the cost of the insurance itself.

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