Medicare advantage member not paying copays

[finalpsychyear]

Hi there. Just wondering what the protocol those in private practice use when you have members who keep saying they can't afford to pay their copays in full and expect it to be waived since other providers do it for them. Is it grounds for discharge if they accrue hundreds in balances but keep providing suspect reasons for not being able to pay.

Are the rules any different for Medicare advantage members? Are you only legally required to provide 30 days and possibly refills along with a discharge letter due to failure to pay and refer out if this is an ongoing issue?

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[Sushirolls]

I think I saw or read or rumor heard you have to do like 2-3 good faith efforts to collect the copays. Only then can you write it off, or the insurance company might come after you for not following the contract.

Up to you. Your practice.

Correlate with state board? Otherwise 30 day closure letter with 30 days minimum; and other options to get care from on the letter; and how to get records. Consider a "final" letter of pay up or services will close first, before the closure letter?

 

[calvnandhobbs68]

Correlate with state board? Otherwise 30 day closure letter with 30 days minimum; and other options to get care from on the letter; and how to get records. Consider a "final" letter of pay up or services will close first, before the closure letter?

Yeah I would put this in writing somehow with sending a bill to the patient clearly stating this before sending a discharge letter out. It's absolutely grounds for discharge if a patient is not following your financial policies (as long as you inform them of the financial policies before you discharge them).

Not sure if different rules apply to medicare advantage members although technically for insurances ive seen its actually a violation of the insurance contract to waive or not require the patient to pay copays...people are still dumb and do it anyway.

 

[VA Hopeful Dr]

That's why you collect the copay upfront and do not see them if they don't have it. That should be your default policy, which you can waive at your discretion.

 

[sloh]

Medicare “advantage” sucks. Even Mayo isn’t accepting it anymore.

Mayo Warns It Won't Take Most Medicare Advantage Plans

Letters to Florida, Arizona patients suggest they enroll in original Medicare with a supplement

www.medpagetoday.com