“No Charge”
As far as the authors have determined, none of the private insurers bans waiving the entire charge for the care. You may also charge for some visits and not for others. Many pediatricians do not charge for the first follow-up visit for otitis media. This increases the likelihood that the child will be brought back for the recheck. The insurance company is also getting a free visit, but at least the patient is getting the care.
“No charge” visits are prohibited if they are part of a fraudulent scheme. For example, a no charge visit is still a patient care encounter and must be fully documented. Assume that a patient has severe asthma and is waiting out a one year preexisting illness exclusion in a health insurance policy. If that patient requires treatment a month before the end of the year waiting period, you have to fully document the treatment even if you do not charge the insurance company for it. You cannot use “no charge” to hide medical information.
You may also deliver nonreimbursable care as part of an otherwise justified office visit and bill the company for the authorized part of the visit. For example, if the insurance doesn’t cover immunizations, then you could do the immunizations at the time you do an authorized well-child checkup, or when the child is in for some other medical condition that is not a contraindication for immunizations. You cannot, however, bill for an office visit when the only reason the patient is being seen is to deliver care that is not authorized under the policy. It would also be improper to “no charge” as a way to waive a copay in order to generate ancillary business for the physician’s office lab or other health services business. In other words, you cannot no charge for the visit and bill the insurance company for $100 worth of lab work that it would not have approved as part of a reimbursed visit.