Ante up: Co-payments not so bad

John Lennon's song, "Imagine," is one of the best songs ever, and I'm willing to arm-wrestle over that one– wait, Lennon wouldn't want that– I'll out-sing anyone instead. The song is about peace and love: utopia. Imagine a world in which you could buy fresh produce, taste different cheeses from around the world, get sashimi-grade fish, and then pay only $25 at the check-out counter. The $25 would be your co-payment, and your grocery insurance would pick up the rest.


Does this sound like medical co-payments?

For most people with private health insurance, their policy requires that they pay a co-payment whenever they see a doctor. It's not co-ed, in which boys and girls live in harmony together at school. It is not Kojak, in which a bald detective finds out what happened to someone's missing mother. It's a co-payment, meaning you pay your pre-determined amount, and your health insurance picks up the rest.

Co-payments should not be confused with deductibles. A health insurance deductible is a yearly amount you owe before your health insurance will start contributing to the bill. So let's say your deductible is $200. That means in one calendar year, your health insurance won't pay a cent for your healthcare until you pay $200 yourself. It is kind of like a sale: once you purchase more than $200, you get 80 percent off everything else. (At Neiman Marcus, that would mean after you buy a pair of socks, you get 80 percent off everything else.)

For those with deductibles over $2,000 (often called, "Hit-by-a-Mack-Truck-Casualty-Insurance"), you will have a long way to go before you have a contribution from your health insurance, unless you get hit by a....

Come January 1 each year, the deductible is reset, and you start the whole process over again. Whee!

A co-payment is due for most medical visits. Don't blame the doctor. Don't yell at the receptionist. You aren't Ms. Diana Ross. It's a policy set by your health insurance. In fact, Medicare requires that all co-payments be collected. Why?

Suppose Dr. Collect Thoughts and Dr. Waive Hello practice on the same block? Dr. Collect follows the rules and always collects co-payments, while Dr. Waive always waives his co-payments. Who do you think patients are more likely to choose as their doctor?

Also, let me do some figures here. (I'm sure many of you readers are going to roll your eyes thinking, "Lordy, he is so off! My bill was $5 billion, not $50." Well, for most office visits, the bill comes to $50.) If your co-payment is $25 or $40 and you don't pay it, the doctor gets only $10-25 for your visit– and going to a movie costs about that much. Your visit also includes the time when the doctor reviews labs, the fact that you have 24-7 coverage to page a physician on call, that you get help with forms that need to be filled out, refilling your medications, etc. So in reality, you are getting a super-sized meal for a low price.

Could you imagine going to the grocery store, buying tons of food and not paying your co-payment when you check out? I have a feeling the grocer will chase you around with a leg of lamb.

I had a woman with her Lexus keys, Kate Spade bag, Prada shoes, and David Yurman bracelets say, "I can't pay my co-payment because I don't have any money with me. Plus, I don't have time to run to the bank because my pedicure appointment is in 15 minutes." This is not Desperate Housewives.


The average medical practice loss in revenues due to unpaid co-payments is $30,000 a year. Medical practices are closing down left and right due to increasing costs and decreasing reimbursements. So if you want good care, do your share.

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