Writing Off Patient Balances

Chip mentioned in last week’s forum that you can bill the insurance and if they pass it onto patient responsibility you can then decide as a business to write that amount off. We did do this at one point. However, we were told this was not allowed if we are under contract with the insurance companies and that we must balance bill the patient. This was mentioned when talking about billing for portal messages. Can you expand on this further? I would really appreciate it.


This is a great question and I look forward to hearing other’s input. My understanding is the clinic is obligated to collect co-pays and any balance that goes to the patient’s deductible. For a service that is denied as not-covered the clinic does have the flexibility to write off. That service thus “fell outside” of the benefits of their plan. Best to have a consistent policy ahead of time so all patients that experience an insurance denial for non-coverage have the same action.

The key thing to keep in mind is that contracts with MCO’s don’t require that you collect the co-payments and deductibles. Rather, they require you make an attempt to collect. It’s a gray area and @Chip was likely alluding to my similar logic.

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This is a grey area.

On one hand, you have your contracts with the payors AND the OIG telling you that you can’t systematically write off patient balances. Worse, you can’t write them off in any manner that gives preference to any class of patient - in other words, write-offs really need to be guided by a financial policy to which everyone adheres.

On the other hand…what payor is going to care if you’re giving away your portal for free? In fact, doing so BENEFITS THEM. They WANT you to feel enough pain that you don’t charge their patients.

As you can see, writing off these nuisance charges - portal fees, telephone fees, depression screening, after-hours codes - perpetuates the devaluation of your services and the relationship you have with your patients.

Personally, as hard as it might be, I’d stick to my guns and charge the patients. YOU ARE WORTH IT.

One way around this is to charge some nominal amount - $5, $10 - and just don’t bill anyone for balances under $20. They can have it tacked on next time they come in.

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Thank you this was helpful and I appreciate your response.