In general, a provider who participates in POS collections will ask for payment of a proposed service sometime before the service is rendered, up to the time the patient is discharged or leaves the office. POS collections ask everyone to pay, from patients who pay solely out-of-pocket to those who are insured and need to pay either a deductible, copay, or coinsurance amount. Almost all private insurance policies require the insured person to pay a co-pay when visiting a doctor or any other health care provider. The co-payment amount varies depending on the insurance plan. Typical co-pays for a visit to a primary care physician range from $15 to $25. Co-pays for a specialist will generally be between $30 and $50.

• Paying Copay Before Seeing Doctors
• Do I Have To Pay A Copay For Every Doctor Visit
• Help Paying Doctor Copays
• Assistance With Doctor Copays
• Paying Copay Before Seeing Doctor
• Do You Pay Copay Before Or After Visit
• Can Doctor Charge More Than Copay

“Yet another area where docs are caught in between the devil and the deep blue sea. Not collecting [a copay] upfront and seeing the patient is actually considered Medicare fraud… [but] ethically and medico-legally you are obligated to provide continuity of care for a patient.” – Urology

Regardless of what insurance a patient has, almost everyone in the United States makes a copay when going to a doctor – but what are doctors to do when a patient cannot afford their copay?

A health insurance copay (or copayment) is a set fee you pay for a doctor visit or prescription. You typically pay it at your appointment or when you pick up a prescription. Learn more about copays and when to pay them below. It's like when friends in a carpool cover a portion of the gas, and you, the driver, also pay a portion. A copay is like paying for repairs when something goes wrong. When your car gets serviced, you pay a set fee to the mechanic, just as you may pay a set fee, like $20, when you.

A doctor from the US specializing in Ophthalmology and Genetics recently asked his fellow physicians on Sermo if they had ever encountered a patient who cannot pay the copay:

If a new patient doesn’t want to pay the co-pay, [that] is an easy decision. The patient is not seen.

[But] what if the patient pays the co-pay for the first visit but needs important follow-up and says they have no money for the co-pay until payday? If patients don’t pay the co-pay at the time of the visit, there is a big chance that they will never pay or take up a lot of staff time to collect later.

The follow-up is important enough that rescheduling the patient until after payday is risky from a malpractice standpoint.

Doctors are struggling to keep their practices afloat, and failure to pay is a serious issue, but at the end of the day physicians are there to practice medicine, support their patients, and put patients first. In response to the question above, many doctors asserted that the posting doctor should see that patient that can’t pay as an exception and just hope the patient pays the copay later:

“It can be very frustrating at times. No checks, no cash, no credit cards to pay co-pay. However, if they’re sick, you have no choice.” – Pediatrics

“You just have to hope that most patients pay. Let staff do the best collections they can. Ophthalmology is a high pay specialty; you will eke out a living somehow.”- Family Medicine

“I am assuming you are concerned the patient legitimately cannot pay. Do what is right for the patient’s health, but you can’t always tell who can’t pay.” – Anesthesiology

“I appreciate the patients who at least apologize and promise to pay when they can. I never turn anyone away who seems legit.” – Ophthalmology

“If the patient is legitimate and unable to pay I usually cut them some slack.” – General Practice

“If it’s urgent/emergent, you have no choice but to see patient as you’ve established a patient-doctor relationship. You will be at risk of being blamed for abandonment if u refused to see patient.” – Anesthesiology

“If the patient’s condition really is serious enough to warrant a worry about malpractice, I’d see them. You might be pleasantly surprised, and they pay after payday. If not, it will probably be worth seeing them for free so as not to worry about the patient, or a malpractice lawsuit.” – Emergency Medicine

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Tai Boxley needs a hysterectomy. The 34-year-old single mother has uterine prolapse, a condition that occurs when the muscles and ligaments supporting the uterus weaken, causing severe pain, bleeding and urine leakage.

Boxley and her 13-year-old son have health insurance through her job as an administrative assistant in Tulsa, Oklahoma. But the plan has a deductible of $5,000 apiece, and Boxley's doctor said he won't do the surgery until she prepays her share of the cost. His office estimates that will be as much as $2,500. Boxley is worried that the hospital may demand its cut as well before the surgery can be performed.

'I'm so angry,' Boxley said. 'If I need medical care, I should be able to get it without having to afford it up front.'

Approximately three-quarters of health care and hospital systems now ask for payment at the time services are provided, a practice known as 'point-of-service collections,' estimated Richard Gundling, a senior vice president at the Healthcare Financial Management Association, an industry group. He could not say how many were doing so for more highly priced services or for patients with high-deductible plans -- situations that would likely result in out-of-pocket outlays of hundreds or thousands of dollars.

Eyeing retailers' practice of keeping credit card information on file, 'there's certainly been a movement by health care providers to store some of this information and be able to access it with patients' permission,' said Mark Rukavina, a principal at Community Health Advisors in Chestnut Hill, Massachusetts, who works with hospitals on addressing financial barriers to care.

But there's a big difference between handing over a credit card to cover a $20 co-payment versus suddenly being confronted with a $2,000 charge to cover a deductible, an amount that might take months to pay off or exceed a patient's credit limit. Doctors may refuse to dispense needed care before the payment is made, even as a patient's health hangs in the balance.

The strategy leaves patients financially vulnerable, too. Once a charge is on a patient's credit card, they may have trouble contesting a medical bill. Likewise, a service placed on a credit card represents a consumer's commitment that the charge was justified, so nonpayment is more likely to harm a credit score.

'For providers, there's more risk with these higher deductibles, because the chance of being able to collect it later diminishes,' Gundling said.

The higher their deductible, the less likely patients are to pay what they owe, according to an analysis of 400,000 claims by the Advisory Board, a health care research and consulting firm.

While more than two-thirds of patients with a deductible of less than $1,000 were likely to pay at least some portion of what they owe, just 36% of those with deductibles of more than $5,000 did so, the analysis found.

Boxley pays $110 a month for her family plan. She could not afford the premiums on plans with lower deductibles that her employer offered. She plans to talk with the doctor and hospital about setting up a payment plan so she can get the surgery in January.

Paying Copay Before Seeing Doctors

'I'll make payments,' Boxley said, although she acknowledged what she could pay monthly would be small. If that doesn't pan out, she figures she'll have to use student loan money she got for graduate school to cover what she owes.

But the practice leaves many patients resentful.

After arriving by ambulance at a hospital near her home in Maitland, Florida, Susan Bradshaw lay on a gurney in her hospital gown with a surgical bonnet on her head, waiting to be wheeled into surgery to remove her appendix. A woman in street clothes approached her and identifiedherself as the surgeon's office manager. She demanded that Bradshaw make her $1,400 insurance payment before the surgery could proceed.

'I said, 'You have got to be kidding. I don't even have a comb,' Bradshaw, a 68-year-old exhibit designer, told the woman on that night eight years ago. 'I don't have a credit card on me.'

The woman crossed her arms and Bradshaw remembers her saying, 'You have to figure it out.'

As providers aim to maximize collections, many contract with companies that help doctors and hospitals secure payments up front, often providing scripts that prompt staff to talk with patients about their payment obligations and discuss payment scenarios as well as software that can estimate what a patient will owe.

But as hospitals and doctors push for point-of-service payments, the risk is that patients will delay care and end up in the emergency room, Rukavina said.

Do I Have To Pay A Copay For Every Doctor Visit

'Patients are essentially paying for their procedures up front,' he said. 'It may not be a significant amount compared to their salary, but they don't necessarily have it available at the time of service.'

Still, experts say that trying to pin patients down for payment in more acute settings, such as the emergency department, may cross a line.

Under the federal Emergency Medical Treatment and Labor Act (EMTALA), a patient who has a health emergency has to be stabilized and treated before any hospital personnel can discuss payment with them. If it's not an emergency, however, those discussions can occur before treatment, said Dr. Vidor Friedman, an emergency physician who is the secretary-treasurer of American College of Emergency Physicians' board of directors.

Help Paying Doctor Copays

Bradshaw finally got her appendix removed by calling a friend, who read his MasterCard number over the phone. The surgery was uneventful, and Bradshaw was home within 24 hours.

Assistance With Doctor Copays

'It's a very murky, unclear situation,' Friedman said of Bradshaw's experience, noting that a case might be made that her condition wasn't life threatening. 'At the very least it's poor form, and goes against the intent if not the actual wording of EMTALA.'

Paying Copay Before Seeing Doctor

Kaiser Health News is national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

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