Co-payments

Waiving Co-payments, Deductibles and Coinsurance

It is unlawful to waive co-payments, deductibles, coinsurances, or other patient responsibility
payments and is specifically prohibited by our contracted managed care partners.
This includes accepting a "lower" co-payment amount than the amount indicated on the member's subscriber ID card, waiving co-payments including for services deemed “professional courtesy” and TWIP (take what insurance pays).

Absent true financial hardship (with complete, current, supporting, documented evidence of such hardship maintained in the patient’s health record), the full amount of the co-pay as well as ALL co-payments, deductibles and coinsurance due and owed must be collected by all network providers.

For CNC Contracts:
Failure to consistently comply for individuals covered by a CNC contracted payor is in violation of the policies of our contracted payors and may result in the termination of your status as a CNC participating provider.

For Medicare:
Failure to comply for individuals covered by Medicare is a violation of the Federal False Claims Act,
Federal Anti-Kickback Statute, and the Federal and State Insurance Fraud Laws. Failure to comply may
result in civil money penalties in accordance with the new provision section 1128 A(a)(5) of the Health
Insurance Portability and Accountability Act of 1996 [section 231(h) (HIPAA).

TO NORTH CAROLINA PROVIDERS ONLY

Due to the recent repeal of the NC co-payment equity legislation, effective October 1,

2007, co-payments for chiropractic visits will change from the Primary Care co-payment to the Specialist co-payment.

Update on CO-PAYMENT change for BCBS

members:

Blue Cross has informed CNC that the change to chiropractic co-payments

will be effective as follows:

     For INDIVIDUAL policies, the co-payments will change on January 1, 2008.

     For GROUP policies, the co-payments will change AS EACH PLAN RENEWS,

     beginning October 1, 2007.

     For NC State Health Plan members, chiropractic co-payment changes are

     effective October 1,  2007 and are listed below, based on plan type:

           PPO Basic Plan specialist co-payment               $50.00

           PPO Standard Plan specialist co-payment         $40.00

           PPO Plus Plan specialist co-payment                  $30.00

Please remember to verify co-payments and deductibles for each patient!