Waiver of deductibles and copays?

[Guest Beth N]

My client is a health care service provider that has a twist on the PPO theme. My client is willing to waive copayments and deductibles for members of certain plans only. Their idea is that the volume that will be generated will outweigh the value of the funds waived.

Can they do this? Has anyone seen it? Has anyone seen any legal challenges to such an arrangement?

[Guest jlcowden]

Beth,

I have seen this done...health plns if they get wind of this practice will likely begin paying claims as if the charge was the original charge plus less the deducible.

Example: Original charge equals $2000, Deductible is $200; Claim will be ajudicated as ($2000 - $200) = $1800 ; which is subjected to a $200 deductible. Claim paid at $1600.

P.S. You may want to post this on the Health Care Board

[Guest Jerry99]

Beth:

Just a word of caution to you on the waiver of co-pays and deductibles by the Provider. There was a court case in Illinois involving that issue and I believe that the court found that the Hospital, by altering its billing, in this case not balance billing the patient for their portion of the plan co-pay, was not permissable. In essence, the hospital was changing its charges. The employer initially paid 80% of the charges. Since the hospital waived the other 20% for the patient, the court found that the employer(payer) would only have to pay 80% of 80% since the original charges were "fradulent". I am referencing this by memory, so some aspects may be missing here...but I would do more checking on this approach. I believe the case was heard in one of the western Illinois Districts.

Jerry99