Collection of copays for ER visits: An important component of benefit management

Blue Cross Blue Shield of Michigan’s hospital participation agreements require that hospitals request payment for copays, deductibles and amounts not paid or expected to be paid by Blue Cross at the time services are provided. An exception to this rule is if a case can be made for a patient’s financial hardship. Hospitals should also have a well-defined copay collection policy.

Collecting copays and deductibles is an important part of Blue Cross’ benefit management strategy — and that of its customers as well — meant to encourage appropriate emergency room usage. Keep in mind that when someone visits the ER, they’re receiving care in one of the most expensive health care settings. And if they visit the ER for a nonemergency condition, they’re not only incurring unnecessary costs, but they’re not availing themselves of the coordinated care their primary care doctor can offer.

Blue Cross recognizes the challenges of collection in an ER environment, but we urge hospitals to make every effort to collect copays and deductibles from patients. Otherwise, members may be inclined to use ERs for nonemergency conditions and hospitals will contribute to their bad debt.

If you have any questions about developing a patient billing and collection policy, talk with your provider consultant.