All co-payments, co-insurance and deductible amounts must be collected by HNS providers for covered services provided. No fees can be charged to the patient OR collected at the time of service for any covered services provided, except for applicable co-payments, deductibles and/or co-insurance. HNS providers cannot waive or reduce co-payments, co-insurance or deductibles.
Exception: If a patient does not wish to have their claims filed to their health care plan, providers must comply with this request. However, such requests may only be honored if the request is properly documented in the patient's health care record and provided patient has paid in full at the time of service.
If you do not collect the appropriate co-pay, co-insurance and/or deductible at the time of service, when you receive your Explanation of Payment, you may bill the patient for any co-payment, deductible or co-insurance up to the plan’s allowed amount.
Some health plans only require a co-payment, while others may have a deductible and co-insurance. Always verify whether the member's plan has a co-payment, deductible and/or co-insurance when verifying benefits.
ADL Forms 
co-payment / co-insurance / deductibles