REP 14 - On giving a deal: navigating discounts, forgiven co-pay and package rates
We all love to get a great deal on a service we need. Providing specials, coupons or package deals is a great way to advertise and bring in new customers, right?
In a regulated health profession, like physiotherapy, things might be a little trickier.
As you read this, please realize that each province has its own standards of practice and advertising regulations. While this may provide some ‘food for thought’ you should check with your provincial college for guidance in your particular jurisdiction.
As a general rule, physiotherapists are allowed to discount their listed prices as they see fit. Sometimes, a patient is unable to pay the full price, so the clinic offers them a special price or provides the service on a pro bono basis.
This is acceptable under most provincial standards of practice, as long as the receipt provided indicates the actual amount paid.
If the receipt is for a higher amount than what the patient actually paid, the client may receive more of a reimbursement than their plan allows, which could put both the patient and the provider in an compromised situation and leave them open to allegations of insurance fraud.
Some clinics like to offer package deals to their clients. You will need to check with your specific provincial regulator for the acceptability of this in your province- but in most cases you cannot do this.
Essentially, you are selling a service which the patient may not need. The patient may buy the package of 10 treatments, but actually be feeling better after only five visits. If they have a package, they may come for additional, unnecessary treatments just so they don’t lose money.
If they choose not to come, they have paid for a service which they did not receive.
Ontario recently changed their regulations around this, and do allow package deals, as long as there is a method for receiving a refund if all of the package is not required. Again, to be sure- check with your college.
Sometimes clinics will offer to forgive the patient’s co-pay fee or use some creative bookkeeping to charge the insurance company more so their patient has to pay less out of pocket.
While at first glance, this may seem like you are being kind to your patient, this is actually a form of insurance fraud and could get both you and your patient into trouble.
Some providers have lost their license or their ability to direct bill insurance companies, and some clients have lost their insurance – and in some cases, their jobs – over issues like this.
Billing for Other Services
What happens when your client runs out of physiotherapy coverage, but still needs physiotherapy services?
We may know that they have coverage for other services that they have not used.
Surely, no harm can come from billing them for another service, like massage therapy or acupuncture, but still providing physiotherapy, right…?
Again, this practice can be viewed as insurance fraud. A physiotherapist can only bill for physiotherapy sessions.
Acupuncture may be part of the treatment we provide in a physiotherapy session, but it must be invoiced as a physiotherapy session. And an insurance company may ask to see your clinical documentation- so you must document what exactly was done during your physiotherapy session.
Contrary to some perception, insurance fraud is not a victimless crime – everyone who pays into a group benefits plan (employers and employees) will need to pay more to offset the high cost of fraud.
Most physiotherapists have entered this profession to help people.
In providing package deals and forgiving co-payment fees, physiotherapists may actually be harming their clients and putting their professional livelihood on the line.
If you are considering offering a special deal or advertising a package, it would likely be in your best interest to think about your plan from multiple perspectives:
- How does this look if I am a potential client?
- An existing client?
- A third-party-payer?
It might be well worth your time to call your provincial regulator and ask their opinion on your plans. It might save a lot of trouble later!
Over to you
Can you see how making these kinds of offers can cause unintended harm?
After reading this, will you make any changes to your current business practices?
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