decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 1 (January)
Check with payer before waiving patient co-pays
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Article Overview
This short payer-compliance article is aimed at coders, practice managers, and pediatric practices that are asked to waive patient co-pays or deductibles. It discusses the issue in the context of payer contract language and a Blue Cross Blue Shield example policy, helping readers understand why the topic matters and where to look for guidance without replacing the underlying contract review.
Why This Topic Matters
Waiving patient cost-sharing can create compliance and reimbursement concerns, so practices need to understand payer rules and contract terms before making exceptions. The article is relevant to offices that want general support for internal policy decisions and payer communication.
What You Will Learn
- Why payer contracts matter when patients ask to waive cost-sharing
- How payer policy language can address deductible, coinsurance, and co-pay waivers
- Why practice managers and coders may need to review contract terms before making exceptions
- How a payer example illustrates the general concern without replacing contract review
Who Should Read This
- Pediatricians
- Practice managers
- Medical coders
- Billing staff
- Family medicine practices
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