To be eligible for urgent care benefits, including through our network of approved community providers, you must: Be enrolled in the VA health care system, and Have received care from us within the past 24 months (2 years) You won’t have to pay any copay for a visit where you’re only getting a flu shot, no matter your priority group. Get the care you need now — for less. When you need care fast, the emergency room (ER) may seem like your only option. But for many situations, urgent care clinics may treat the same conditions — at up to $2,000 less than the ER. Find Network Urgent Care.
“Yet another area where docs are caught in between the devil and the deep blue sea. Not collecting [a copay] upfront and seeing the patient is actually considered Medicare fraud… [but] ethically and medico-legally you are obligated to provide continuity of care for a patient.” – Urology
Regardless of what insurance a patient has, almost everyone in the United States makes a copay when going to a doctor – but what are doctors to do when a patient cannot afford their copay?
A doctor from the US specializing in Ophthalmology and Genetics recently asked his fellow physicians on Sermo if they had ever encountered a patient who cannot pay the copay:
If a new patient doesn’t want to pay the co-pay, [that] is an easy decision. The patient is not seen.
Cigna Urgent Care Copay
[But] what if the patient pays the co-pay for the first visit but needs important follow-up and says they have no money for the co-pay until payday? If patients don’t pay the co-pay at the time of the visit, there is a big chance that they will never pay or take up a lot of staff time to collect later.
The follow-up is important enough that rescheduling the patient until after payday is risky from a malpractice standpoint.
Doctors are struggling to keep their practices afloat, and failure to pay is a serious issue, but at the end of the day physicians are there to practice medicine, support their patients, and put patients first. In response to the question above, many doctors asserted that the posting doctor should see that patient that can’t pay as an exception and just hope the patient pays the copay later:
“It can be very frustrating at times. No checks, no cash, no credit cards to pay co-pay. However, if they’re sick, you have no choice.” – Pediatrics
“You just have to hope that most patients pay. Let staff do the best collections they can. Ophthalmology is a high pay specialty; you will eke out a living somehow.”- Family Medicine
“I am assuming you are concerned the patient legitimately cannot pay. Do what is right for the patient’s health, but you can’t always tell who can’t pay.” – Anesthesiology
“I appreciate the patients who at least apologize and promise to pay when they can. I never turn anyone away who seems legit.” – Ophthalmology
“If the patient is legitimate and unable to pay I usually cut them some slack.” – General Practice
“If it’s urgent/emergent, you have no choice but to see patient as you’ve established a patient-doctor relationship. You will be at risk of being blamed for abandonment if u refused to see patient.” – Anesthesiology
“If the patient’s condition really is serious enough to warrant a worry about malpractice, I’d see them. You might be pleasantly surprised, and they pay after payday. If not, it will probably be worth seeing them for free so as not to worry about the patient, or a malpractice lawsuit.” – Emergency Medicine
Are you a doctor? Join Sermo to contribute to the conversation on the business and practice of medicine!
CareSource has a network of doctors, hospitals and other providers. If you use providers who are not in our network, the plan may not pay for these services unless you needed emergency services or CareSource specifically authorized the services.
Use our Find a Doctor/Provider tool to see if your doctor is in our network.
Learn more about out-of-network coverage by reviewing your Evidence of Coverage on our Plan Documents page.
2021 Copayments and Fees
| Other Medical Benefits (In-Network) | ||
| Inpatient Hospital Care | Days 1-5: $365 per day Days 6-90: $0 copay per day | Days 1-7: $285 per day Days 8-90: $0 copay per day |
| Skilled Nursing Facility (SNF) | Our plan covers up to 100 days in an SNF: Days 1-20: $0 copay Days 21-100: $184 per day | Our plan covers up to 100 days in an SNF: Days 1-20: $0 copay Days 21-100: $184 per day |
| Outpatient Hospital Services | $295 copay | $295 copay |
| Ambulatory Surgical Center | $250 copay | $250 copay |
| Diabetes Testing Supplies | $0 copay | $0 copay |
| Durable Medical Equipment (DME) | 20% coinsurance | 20% coinsurance |
| Home Health Care | $0 coinsurance | $0 coinsurance |
| Ambulance Services | $225 copay | $225 copay |
| Urgent Care | $45 copay | $35 copay |
| Emergency Care | $90 copay | $90 copay |
| Lab Services and Other Tests (In-Network) | ||
| Laboratory Tests | $35 copay | $0 – $10 copay |
| Diagnostic Tests (Non-Radiology) and Procedures | $35 copay | $0 – $10 copay |
| Diagnostic Radiology Tests (such as MRIs, CT scans) | $175 copay | $150 copay |
| Outpatient X-Rays | $50 copay | $25 copay |
Preventive Care
You pay nothing for in-network preventive care. We encourage you to take advantage of preventive services, which are covered by CareSource Medicare Advantage. We also offer CareSource24®, our 24/7/365 nurse advice line. Call the the toll-free number on your CareSource member ID card.
Prior Authorization
Some services require prior authorization from CareSource. This means your doctor or health care provider must get approval from CareSource before you can get the service.
Usually your primary care provider (PCP) will ask for prior authorization from us and then schedule these services for you. If you are seeing a specialist, he or she will get approval from your PCP. Then your services will be scheduled. If you have questions about the prior authorization process or status, please call Member Services. CareSource has a network of doctors, hospitals, pharmacies and other providers. In order to have your health care services covered by your plan, you must get them from a network provider. You can find the most current list of network providers using our online search tool, Find a Doctor, under the Quick Links to the left. Select the state where you live and your health care plan to get started. Bad seed customs pandora apk download. It is important to know which providers are part of our network because – with limited exceptions – while you are a member of our plan, you must use network providers to get your medical care and services. The only exceptions are: Please refer to the Evidence of Coverage for your plan on the Plan Documents page for full information on in-network and out-of-network copayments, as well as applicable conditions and limitations. If you get sick or hurt while traveling outside of our service area, you can get medically necessary covered services from a provider not in our network. Prior to seeking urgent care, we encourage you to call your PCP for guidance, but this is not required. You should get urgent care from the nearest and most appropriate health care provider. React native markdown render. Emergency care is covered both in and out of our service area. If you receive emergency care from a provider who is not a network provider, or urgent care services outside the service area, you will need to submit the bill you receive to CareSource with a claim form found on our Forms page. You may also obtain a claim form by calling Member Services at 1-844-607-2827(TTY: 711). We are open 8 a.m. – 8 p.m. Monday through Friday, and from October 1 – March 31 we are open the same hours 7 days a week. Out-of-network/non-contracted providers are under no obligation to treat CareSource members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services. This information is not a complete description of benefits. Call 1-844-607-2827 (TTY: 711) for more information.Network Providers
Network Exceptions
Medicare Urgent Care Copay Cards
When You Are Outside of Our Service Area