• Patient Copay Assistance Programs
• Patient Copay Responsibility Letter

Karen Taylor had been coughing for weeks when she decided to see a doctor in early April. COVID-19 cases had just exceeded 5,000 in Texas, where she lives.

NOTE: Veterans who have a service-connected rating of 10% or higher are not required to pay a copayment for outpatient medical care. If you do, you are obligated to pay it. – Many patients claim that their earlier doctors never collected a copay from them so they think no doctors should expect to collect copays. First, doctors will think they are lying. Second, if they are not, those other doctors are guilty of.

Cigna, her health insurer, said it would waive out-of-pocket costs for “telehealth” patients seeking coronavirus screening through video conferences. So Taylor, a sales manager, talked with her physician on an internet video call.

The doctor’s office charged her $70. She protested. But “they said, ‘No, it goes toward your deductible and you’ve got to pay the whole $70,’” she said.

Don't Miss A Story

Subscribe to KHN’s free Weekly Edition newsletter.

Policymakers and insurers across the country say they are eliminating copayments, deductibles and other barriers to telemedicine for patients confined at home who need a doctor for any reason.

“We are encouraging people to use telemedicine,” New York Gov. Andrew Cuomo said last month after ordering insurers to eliminate copays, typically collected at the time of a doctor visit, for telehealth visits.

But in a fragmented health system — which encompasses dozens of insurers, 50 state regulators and thousands of independent doctor practices ― the shift to cost-free telemedicine for patients is going far less smoothly than the speeches and press releases suggest. In some cases, doctors are billing for telephone calls that used to be free.

Patients say doctors and insurers are charging them upfront for video appointments and phone calls, not just copays but sometimes the entire cost of the visit, even if it’s covered by insurance.

Despite what politicians have promised, insurers said they were not able to immediately eliminate telehealth copays for millions of members who carry their cards but receive coverage through self-insured employers. Executives at telehealth organizations say insurers have been slow to update their software and policies.

“A lot of the insurers who said that they’re not going to charge copayments for telemedicine ― they haven’t implemented that,” said George Favvas, CEO of Circle Medical, a San Francisco company that delivers family medicine and other primary care via livestream. “That’s starting to hit us right now.”

One problem is that insurers have waived copays and other telehealth cost sharing for in-network doctors only. Another is that Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare and other carriers promoting telehealth have little power to change telemedicine benefits for self-insured employers whose claims they process.

Such plans cover more than 100 million Americans — more than the number of beneficiaries covered by the Medicare program for seniors or by Medicaid for low-income families. All four insurance giants say improved telehealth benefits don’t necessarily apply to such coverage. Nor can governors or state insurance regulators force those plans, which are regulated federally, to upgrade telehealth coverage.

“Many employer plans are eliminating cost sharing” now that federal regulators have eased the rules for certain kinds of plans to improve telehealth benefits, said Brian Marcotte, CEO of the Business Group on Health, a coalition of very large, mostly self-insured employers.

For many doctors, business and billings have plunged because of the coronavirus shutdown. New rules notwithstanding, many practices may be eager to collect telehealth revenue immediately from patients rather than wait for insurance companies to pay, said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.

“A lot of providers may not have agreements in place with the plans that they work with to deliver services via telemedicine,” she said. “So these providers are protecting themselves upfront by either asking for full payment or by getting the copayment.”

David DeKeyser, a marketing strategist in Brooklyn, New York, sought a physician’s advice via video after coming in contact with someone who attended an event where coronavirus was detected. The office charged the whole visit — $280, not just the copay ― to his debit card without notifying him.

“It happened to be payday for me,” he said. A week earlier and the charge could have caused a bank overdraft, he said. An email exchange got the bill reversed, he said.

With wider acceptance, telehealth calls have suddenly become an important and lucrative potential source of physician revenue. Medicare and some commercial insurers have said they will pay the same rate for video calls as for office visits.

Some doctors are charging for phone calls once considered an incidental and non-billable part of a previous office visit. Blue Cross plans in Massachusetts, Wyoming, Alabama and North Carolina are paying for phoned-in patient visits, according to America’s Health Insurance Plans, a lobbying group.

“A lot of carriers wouldn’t reimburse telephonic encounters” in the past, Corlette said.

Catherine Parisian, a professor in North Carolina, said what seemed like a routine follow-up call with her specialist last month became a telehealth consultation with an $80 copay.

“What would have been treated as a phone call, they now bill as telemedicine,” she said. “The physician would not call me without billing me.” She protested the charge and said she has not been billed yet.

By many accounts, the number of doctor encounters via video has soared since the Department of Health and Human Services said in mid-March that it would take “unprecedented steps to expand Americans’ access to telehealth services.”

Medicare expanded benefits to pay for most telemedicine nationwide instead of just for patients in rural areas and other limited circumstances, HHS said. The program has also temporarily dropped a ban on doctors waiving copays and other patient cost sharing. Such waivers might have been considered violations of federal anti-kickback laws.

At the same time, the CARES Act, passed by Congress last month to address the COVID-19 emergency, allows private, high-deductible health insurance to make an exception for telehealth in patient cost sharing. Such plans can now pay for video doctor visits even if patients haven’t met the deductible.

Dozens of private health insurers listed by AHIP say they have eliminated copays and other cost sharing for telemedicine. Cigna, however, has waived out-of-pocket costs only for telehealth associated with COVID-19 screening. Cigna did not respond to requests for comment.

Teladoc Health, a large, publicly traded telemedicine company, said its volume has doubled to 20,000 medical visits a day since early March. Its stock price has nearly doubled, too, since Jan. 1.

With such a sharp increase, it’s not surprising that insurers and physicians are struggling to keep up, said Circle Medical CEO Favvas.

“It’s going to be an imperfect process for a while,” he said. “It’s understandable given that things are moving so quickly.”

Abbie VanSickle, a California journalist, wanted her baby’s scheduled wellness visit done remotely because she worried about visiting a medical office during a pandemic. Her insurer, UnitedHealthcare, would not pay for it, the pediatrician told her. Mom and baby had to come in.

“It seems like such an unnecessary risk to take,” VanSickle said. “If we can’t do wellness visits, we’re surely not alone.”

A UnitedHealthcare spokesperson said that there was a misunderstanding and that the baby’s remote visit would be covered without a copay.

Jacklyn Grace Lacey, a New York City medical anthropologist, had a similar problem. She had to renew a prescription a few weeks after Cuomo ordered insurers to waive patient cost sharing for telehealth appointments.

The doctor’s office told her she needed to come in for a visit or book a telemedicine appointment. The video visit came with an “administrative fee” of $50 that she would have had to pay upfront, she said — five times what the copay would have been for an in-person session.

Patient Copay Assistance Programs

“I was not going to go into a doctor’s office and potentially expose people just to get a refill on my monthly medication,” she said.

By getting patients to take on some of the financial responsibility for the use of services, copays are the insurance companies’ way of discouraging unnecessary medical treatments.

Procuring copays, however, isn’t always easy. And the truth is, during this time of declining reimbursement rates, most practices can’t afford to waive such a significant share of revenue.

Fortunately, you’re not alone in the mission to collect copays. Technology can greatly aid in the effort. Today, we review three key technologies that can keep your patients from skipping out on the bill.

Patient Portals

The rise of our digital culture has created consumers who not only expect businesses to have an online presence, but also to provide the ability to conduct financial transactions online. The health industry is no exception.

Patient portals are one way to meet patients’ electronic payment needs.

The best portals allow patients to pay their medical bills online from the comfort of their home. They’re a secure way for practices to safely send patients statements and reminders. This will steer you clear of violating HIPAA standards.

Practice Management Software

Practice management software that organizes patient data into an intuitive dashboard can provide you with a complete picture of your patients’ financial standing.

The patient dashboard should display patient demographics, insurance information, history with your practice, and account details including outstanding balances.

PM software should also verify insurance eligibility prior to a patient’s visit. This will let you inform the patient of their copay amount before they ever get to your office.

By being proactive about patient copays, you increase the chance of patients coming prepared to pay during their visit.

Promise of Payment Log

Use Microsoft Office’s Excel application to create a Promise of Payment log for patients who chose not to pay at the time of service. It should contain their name, phone number, email, amount owed and the date they promised to send payment.

This will help keep your pending payments accessible, legible and better organized. Therefore, no failure of payment will go by unnoticed.

On a final note, make sure your practice is equipped to accept credit cards. Credit card machines are a great tool for collecting patient payments. Most patients have credit cards, and they don’t even have to be present to use them.

For instance, when a patient forgets to bring their wallet or checkbook to the clinical encounter, they can simply call you from home with their account number. It’s convenient for the patient and ensures your practice gets fully reimbursed.

Because copayments can be up to 20% of a medical reimbursement, it’s absolutely critical for your practice to do whatever it takes to get paid accordingly. Leverage these three technologies to make sure you don’t miss out.

Check out this upcoming webinar with Rosemarie Nelson to discover how an EHR can automate operations and reduce overhead.

Patient Copay Responsibility Letter

Free e-book:

Pros and Cons of In-house vs. Outsourced Medical Billing