Why do providers have to collect the co-pays that are mandated by health plans? Why don’t health plans collect those?

Can we talk about the fact that payors invented and mandate co-pays to reduce utilization of their product but require health care providers to collect those? I’m not a provider but I was listening to a podcast of a revenue cycle leader for a health system point out this simple fact and I can’t believe I’ve never thought of that? (We can talk on another thread about why there is a whole revenue cycle industry exclusive to health care). I mean, the payor has leverage over the typical provider due to scale, but what about markets like Sacramento or NE Indiana or Philadelphia where the large health systems have massive power? Why don’t they insist that, if the payors want their members to have “skin in the game,” they make their members pay the co-pay to the payor before authorizing the visit/procedure/etc? It creates a TON of work/cost/bad debt/litigation that could be avoided if the payor took that payment before authorizing care. Obviously the “pre-pay” doesn’t work in emergency care, but why should the payor make the provider go after the co-pay in those situations?

https://ift.tt/Rz35QMk Submitted October 05, 2023 at 06:48AM by messageinabubble https://ift.tt/2vPgpZW