Freebies and discounts are a time-honored business tradition. In many industries, throwing in something “on-the-house” is a sound marketing tactic or a built-in aspect of business-as-usual (at least for mattress salesmen waiving the cost of the bed frame when you buy the deluxe model, or for lawyers and accountants who usually charge $120 an hour, “but in your case…”).
Acupuncturists billing insurance for their services, however, aren’t privy to such strategies. In the old days of healthcare (before the institution of health insurance in the U.S.), it was normal for providers to discount their services or waive patient costs at their own discretion. The provider’s intent – whether to assist a patient who’s struggling financially, to provide a professional courtesy, or simply to do something nice – was irrelevant.
But that world of free-for-all freebies is a relic of the past and not applicable when it comes to billing insurance for acupuncture. Due to the involvement of insurers, the provider’s intent when offering something gratis is very relevant – and very hard for insurers to make peace with. It may seem like a harmless favor to waive a patient’s financial responsibility for a visit, but it’s actually anything but.
Why so? In our current healthcare environment, high-deductible plans are becoming the most common kind, and patients are responsible for an ever-increasing portion of their own healthcare costs. Insurers are highly mindful of this in the post-Affordable Care Act landscape; now that all citizens are required to secure health insurance or face monetary penalties (thanks to the so-called “individual mandate”), patient cost sharing is viewed by commercial and government payers as an important way to hold down the rising cost of medical care.
By waiving co-pays, providers throw that balance out of whack. That’s why many insurers – private and public – pack their contracts with clauses requiring you to collect patient co-pays and deductibles.
Those clauses also keep you accountable to another payer concern: what constitutes “usual and customary.” In the eyes of insurers, if an acupuncturist routinely waives the patient portion of the fee, the “usual and customary” rate is really lower than what was agreed to by both parties. As such, systemic fee-waiving amounts to more than just breach of contract – it’s fraud, and you can be taken to court for it.
Of course, all of the above isn’t to say that waiving co-pays is always entirely out of the question. Discretion is allowed on an individual basis in cases of patient hardship – but acupuncturists should be careful to institute a clear policy on their criteria for write-offs and to document each instance diligently, ideally with a standardized form logged with all medical billing information.
Ultimately, never put “on-the-house” offers on the table in instances of anything other than undue financial hardship. If not because of the potential legal consequences, then simply because it’s unwise. With insurers paying less and patients paying more, following in the footsteps of other industries’ freebie “traditions” can take a major chunk out of your bottom line.
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