Cleveland Clinic reverses ‘pay now’ co-pay policy after criticism

CLEVELAND, Ohio — Before, Cleveland Clinic patients were going to be turned away if they couldn’t immediately pay their insurance co-pay. Now, in a reversal announced Wednesday, Clinic patients can once again see a doctor without paying first.

The Clinic — which came under criticism for the policy that patient advocates said would limit access to care for the poor — now will allow those with commercial insurance or Medicare Advantage, who can’t pay their co-pay at the time of their non-emergency outpatient visit, to set up a 0% interest payment plan.

Patient appointments won’t be canceled or rescheduled for those who can’t pay immediately, the Clinic said Wednesday in a letter to patients and a news release. And, patients who do not have the means to pay for services upfront can request financial assistance.

“It was never our intention to not have patients access care,” a Clinic spokeswoman said. “We felt that it was the right thing to do to provide an option for patients to be able to make their copays.”

In mid-May, the Clinic announced that some appointments would be canceled or rescheduled if patients could not pay upfront, starting on June 1. The Clinic’s reversal of that policy comes after it faced significant backlash for the move.

Over the past decade, the health system has seen the growth in out-of-pocket costs for patients through their insurance plans. In 2024, more than half of co-pays were not paid for Clinic services, the health system said.

Collecting co-pays at the time of an office visit “maintains our ability to provide the highest quality care to every patient who needs our services and invest in the communities we serve,” the health system said in a Wednesday statement.

Some observers told cleveland.com they understood the Clinic’s crackdown on payments, pointing out that almost all other services are paid for when rendered.

But others pointed out that cancelling appointments for lack of payment could delay care and send low-income families to University Hospitals or MetroHealth System, which do not turn away patients who can’t immediately cover their co-pay.

Cleveland City Council took up the issue, demanding answers from Clinic executives and calling the co-pay collection policy a “slap in the face” to residents.

Vicki Johnson, the Clinic’s chief community officer, told City Council that with $70 million in unpaid copays in 2024 and a slim 1.7% operating margin, the Clinic must collect more revenue to maintain services and invest in community programs.

“We are a business,” Johnson told City Council on May 19. “Our margins are small and we’re trying to do the best we can to be lean.”

Reached Wednesday evening, Ward 5 councilman Richard A. Starr applauded the change.

“I will say kudos and hats off to the administration and the executive leadership of the Cleveland Clinic for hearing out some of the thoughts that myself and my colleagues made, as well as the people,” Starr said. “This decision to reverse the new policy just shows that they are listening to the community.”

Starr credited council’s strong partnership with the Clinic as one reason for the health system’s change of heart.

“I think there was pressure (against the Clinic),” Starr said. “But then there was also a point where we have to come to our senses to say, what do we do to move forward, to make this right?”

A Clinic spokeswoman denied that the medical system acted because of outside pressure.

“Now we realize that it may have been perceived that we weren’t going to see the patients,” the spokeswoman said. “So this is a way to make sure that people, that maybe don’t have the means to pay the $35 or $50 copay, have an option to be able to get care.”

The collection policy, explained

The original co-pay policy from earlier this month said that the health system would collect copays upfront for services that don’t require an inpatient hospital stay, including scheduled office visits, outpatient diagnostic tests and outpatient procedures and in-office procedures.

Those unable to pay would have their appointments rescheduled or canceled, the Clinic said at the time.

This applied to patients with commercial insurance. It did not apply to patients with Medicaid or traditional Medicare.

Under Wednesday’s policy update, co-pays for these services and patients are still expected, but not required, at the time care is provided, the Clinic said.

The Clinic has offered financial assistance programs in the past, but the 0% interest payment plan is new for co-pays, the health system said.

Clinic’s investment in the community

In a Wednesday statement announcing the updated co-pay collection policy, the Clinic stressed that it helps communities and patients in need.

In 2023, for instance, the Clinic said it helped more than 100,000 patients who could not afford care by providing $261.3 million in financial assistance.

It has also invested millions of dollars in recent years to make local neighborhoods safer and healthier, including money to fight childhood hunger, construct affordable housing and remove lead hazards from homes and daycares.

Collecting co-pays in a timely fashion helps the health system afford to support community health and help those patients who need financial assistance to pay for health care, a spokeswoman said.