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Old 02-09-2013, 10:42 AM   #16
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Originally Posted by sunshine1178

Interesting that you're in Indiana. We have the exact same problem with a specialist in Munster. I let United Healthcare know that I am *not* amused, and let the billing office know that they will receive in network money, and no further business from us.
Your not far from me. The office with the issue was a St. Anthony pediatrician. It is nearly impossible to deal with their billing office, the left hand apparently has no idea what the right hand is doing. Grrr. It is a huge difference for us between in network and out of network. The department of insurance did investigate and specifically stated it was the tax id issue and operating under the one but listing with our insurance under the other but since we are self funded that they couldn't do more. Aggrevating to say the least and no I did not return.

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Old 02-09-2013, 08:42 PM   #17
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Originally Posted by Shagley View Post
This is probably common knowledge for many people, but something that took me by suprise. Make sure that when a doctor's office tells you that you owe a copay, that you double check with your insurance company to make sure you really do owe it.

I have been having outpatient physical therapy, and on my 1st visit the the therapy office informed me that they contacted my insurance company and that I have a $20 copay per visit and I have to pay the copay at the time of the appointment. I have never had physical therapy before, so I didn't even question it. I have now gone to therapy 10 times and paid my $20 copay each time. Yesterday I was looking at the EOB that the insurance company sent me for my therapy claim (it was the first one I received since starting therapy) and it said that I should have $0 copay on each visit. I looked at my insurance website, and sure enough it said I should have $0 copay for physical therapy. The story gets long from here, but basically what happened is that the physical therapy office charged me the copay for a Specialty Office Visit, but then billed my insurance company for Physical Therapy (which they cannot do, and my insurance company on a 3 way call told them that they cannot do this).

My budget point is this - always check your insurance policy and the EOBs (Explanation of Benefits) that you receive from your insurance company to make sure your copay is being charged correctly. If you have been charged a copay at the office, then your EOB says you should have a $0 copay, request a refund of your copay from the doctors office. Also, doctors offices deal with a lot of different insurance policies, all which have different fees, so don't just trust them (like I did) to correctly tell you what your copay should be.

The embarassing part is --- I work in hospital medical billing and I still got caught being naive with this
actually quite common...PT after a surgery per say, is not generally charged a co pay as long as a surgeon requests it...but after an accident or such, you pay the co pay. Yeah, great point, know your policy
Heres hoping you get a full refund....
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