QUESTION: The following question is pertinent to many doctors that accept insurance company payments. The insurance company requires that the doctor charges the patient a copayment that typically ranges from $25 to $30. Requiring a copayment (which the doctor keeps) is a practice instituted by the insurance company to help ensure that people go to the doctor when they really need to and not whenever they feel like it, which may occur if a visit to the doctor was completely free.
However, If the doctor has patients that cannot afford the copayment, may the doctor forgo the payment in those cases?
ANSWER: If the doctor’s agreement with the insurance company specifically requires collecting copayments from all patients, then forgoing them could potentially violate contractual obligations and involve elements of deception (Genaivas Daas) and possible theft from the insurance company. The prohibition against deception is codified in Shulchan Aruch Choshen Mishpat 228:6.
On the other hand, there are studies that show that copayments can cause families and patients to compromise medical care and not seek treatment for medical conditions that require it. This possibly conflicts with the very reason that a doctor entered the field of medicine to begin with. The obligation to heal is a Mitzvah and is derived from the Passuk, “...and you shall restore it to him." (Devarim 22:2), which Chazal interpret as including the Mitzvah to heal (Bava Kamma 81b). Further, the Shulchan Aruch states that a doctor is obligated to heal and that one who does not do so is likened to one who sheds blood. (Yoreh Deah 336:1)
Accordingly, it would appear that foregoing a copayment for indigent individuals who otherwise would not go to the doctor would be permitted. However, an effort to live up to the contract that the doctor has with the insurance company and mitigate the concerns of possible theft and Geneivas Daas must still be made.
One possibility is to have the doctor instruct his staff to keep an envelope of petty cash in the desk and actually loan the money to the indigent patient by transferring the money from the petty cash envelope and placing it in the client’s folder, writing down the loan and the name of the patient. Then, sometime in the future, the doctor can forgo the loan if the patient is still not in a position to pay. In this scenario, the doctor is still charging the patient and collecting the copayment even if he may not ultimately receive the money. In such a scenario, at least the doctor is complying with the words of the insurance contract even if he is not complying with the spirit of it.
