Is it acceptable to increase fees to patients with insurance?

• A. True
• B. False
• C. Sometimes allowed
• D. Not specified

Answer: (B)

Pricing should be fair and consistent regardless of whether a patient has insurance. The fee for a given service is determined by your standard charge for that service, and the insurance plan then affects what the patient actually pays through discounts, co-pays, and allowed amounts. Increasing fees specifically for insured patients crosses ethical lines and can be seen as discriminatory billing or an improper practice, even if a contract with a payer exists. You bill according to the agreed-upon contract for insured patients, and the patient’s responsibility is based on that contract, not on inflating the base charge for those with insurance. In short, it’s not acceptable to raise fees merely because a patient has insurance.