QUESTION:



I just took the jurisprudence exam. In preparation, Ie came across 
WAC

246-808-630. It appears that we can waive co-pays as long as we 
tell the

insurance company we're doing it. I'm asking you for some clarity



RESPONSE:



As usual, the response is more complicated.



First, no matter what the regulation may purport to allow, your 
MCO contract

does not allow you to waive co-pays or deductibles.  Disclosing 
that you are

doing it only makes the job of the carrier justifying your 
termination

easier.



Second, when you provide any services at a discount, which 
includes waivers,

you have to provide the patient with a disclosure statement which 
spells out

certain parameters of the discount and have the patient sign it.  
WAC

246-808-600



Third, although I cannot find any statutory definition to delineate 
co-pays

from deductibles, since deductible is the amount unpaid by the 
carrier and

is the patient's responsibility, a co-pay could be deemed lumped 
within the

"deductible".  RCW 48.30A.015 prohibits a regular practice of 
waiving or

discounting "deductibles".  Whether this prohibition covers copays 
remains

somewhat undetermined.  Violation of RCW 48.30A.015 the first 
time is a

gross misdemeanor, and the second and subsequent time is a Class 
C felony.

Violation of state or federal law in the practice of chiropractic

constitutes "unprofessional conduct" and could justify discipline 
against

your license.



I think the practice of waiving co-pays, with or without 
disclosure, is

questionable and risky.



John C. Peick

2000-112th Avenue NE

Bellevue, WA 98004-2319

425-462-0660

425-462-7203

jpeick@peick-usa.com