Generally, anesthesiologists know professional courtesy, co-payment waivers and discounts for cash payments could cause compliance issues. However, there are nuances to each of the three situations, according to an Anesthesia Business Consultants blog.
1. Professional courtesy. It is legal to provide courtesy to physicians in the community, their families and their staff, generally speaking. However, it becomes illegal is when courtesy targets physicians or people who are in a position to refer federally-insured patients to the practice.
2. Waiving co-pays or accepting "insurance only" as payment. Patient co-pay waivers are generally illegal and certain states have deemed "insurance only" billing as fraud. There is however, one limited exception to the prohibition of co-pay waivers — a waiver based on demonstrated financial hardship. Practices must determine a process in terms of what patients need to provide to qualify for this exemption.
3. Discounts for cash payment. The practice of bypassing insurance is legal, but anesthesiologists need to check whether undercutting their own negotiated rates violates any of their health plan contracts.