The most common ways physicians reduce the cost of care for patients are waiving the copay (“insurance only”) and giving the patient a discount on the care. In most situations, both private insurers and the federal government ban waiving the copay. (Medicare has some provisions allowing the copay to be waived for documented indigency.) They do this because the copay is meant to discourage casual trips to the physician. The theory is that making the patient share the cost of treatment will make the patient a more sophisticated health care consumer. The reality is that the copay limits access to care for many people. The less care the patient seeks, the less money the health plan has to pay to physicians and hospitals for that care. Both private insurers and Medicare require the physician to make reasonable efforts to collect copays that are billed to the patient.