Patients with medical insurance who require treatment by a physician may have an initial out-of-pocket liability. The cost and type of this liability varies by the location of the visit, but in general, most insured patients have to pay up-front when visiting the doctor.
Types of Liability
Patients with ordinary commercial insurance generally have direct liability for co-pays, co-insurance and insurance deductibles. The latter two types of liability are typically billed to the patient after care is delivered, although most hospitals require payment in full of large deductibles for elective surgeries. However, a co-pay is paid up-front; it's usually a small expense -- for example, $20 for a routine doctor's visit or $50 for an emergency visit -- but it must be paid at the time service is delivered.
A federal law, the Emergency Medical Treatment and Labor Act, forbids hospitals from asking any questions about payment or insurance until after a patient has been evaluated by a physician. Only after seeing an emergency physician will a hospital registrar visit the patient to collect insurance and demographic information and collect applicable co-pays. In all other situations, a person may be asked about his ability to pay at the time he checks into the office, hospital or clinic.
Although most doctor's offices and hospitals accept a wide variety of payment methods, sometimes a patient simply cannot afford even a small co-pay. Although co-pay collection is expected at the time of service, some doctor's offices and most hospitals may be willing to bill the patient instead of receiving payment at the time of service. Call the provider to ask if a co-pay can be billed before arriving -- it may be easier to make financial arrangements by telephone than to try to set something up when you arrive.
Government Insurance and Self-Pay
Some insurances, like Medicare, do not assess co-pays. A co-pay requirement generally only applies to commercial coverage like health maintenance organizations or preferred provider organizations.
Patients without insurance do not have a co-pay; instead, they pay receive invoices for the full cost of care. The invoice is due generally within 30 days, although most hospitals are willing to negotiate discounts for prompt payment or payment plans for large balances.
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