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Old 02-08-2013, 02:42 PM   #1
Shagley
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Check your medical copays to make sure you aren't being overcharged.

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
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Old 02-08-2013, 03:16 PM   #2
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so now you just need to make sure you get that $200 back from the company.
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Old 02-08-2013, 03:25 PM   #3
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It's easy to do, and sometimes it isn't very clear - even after you've talked to the insurance company. I hit "max out of pocket" last year, and I called my insurance company to find out what that covered. They were very clear that it didn't include copays(doctor or emergency room), prescriptions, or out of network.

So I went on paying copays for my doctor visits until my doctor's office started refunding me for the copay. I don't get EOBs for normal office visits, so I had no idea until I got a check. That balanced out the ER visit where they admitted me, but coded it as an observation admission. I don't have an ER copay if they admit me, but observation admissions have a copay.
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Old 02-08-2013, 03:30 PM   #4
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my father had a similar situation. he never got his new insurance card for 2013 and went to the doctor's twice. He knew how much the copay was but the office wouldn't listen to him. they made him pay the copay from last year. so now I have to contact the office and try to get his money back. you are right, don't always trust the doctor's office to know all the answers. I have argued many times that all family members get an annual physical every year with no copay and the office always says we still have a copay but I am insistent and I never do get a bill later on.
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Old 02-08-2013, 03:43 PM   #5
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Quote:
Originally Posted by pyrxtc View Post
so now you just need to make sure you get that $200 back from the company.
Oh yes, I plan on it The insurance company said to wait until all of the claims have gone through, and then they will assist me in getting the $200 back. The physical therapy place still refuses to admit that they did anything wrong, even though the insurance company told them that they cannot legally bill me the way they did it (we had a 3 way call going). The insurance company said not to worry about it right now, and once the physical therapy office got paid by the insurance company, then the insurance company will assist me in getting my money back. I have all my EOB's that say I have $0 copays, and I have all my receipts saying that I paid $20 copays for each visit. I won't let this drop!!
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Old 02-08-2013, 04:01 PM   #6
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The crazy thing is that this PT (physical therapy) office that I have been going to is right next door to where I work. I have been walking over there for my appointments, and then I only live about 2 miles away. My Boss also goes to PT, and she goes to the exact same PT company, but to an office across town closer to her house. When I told her what was going on, she said that in the 3 months that she has been going to therapy at the other office, she has never been charged a copay. She has the same insurance that I do, and it is the exact same company, just a different office location. I called over to the office across town to ask them what my copay would be if I switched to their office, and they verified that I would have $0 copay. I guess I will be changing offices. It is not nearly as convenient, but since I still have to go twice a week, and the other office still won't admit that I don't owe a copay, I guess that is my best option.
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Old 02-08-2013, 05:01 PM   #7
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also always make sure that your insurance company is paying the correct amount too - I can't tell you how many times I have had to call my insurance company to have a claim reprocessed and have them correct it.

It makes you wonder how many claims are processed wrong by insurance companies to their benefit that nobody ever catches
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Old 02-08-2013, 05:08 PM   #8
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We were overcharged on a copayment for an office visit. The provider admits we were over-charged, but simply refuses to refund our money. They tell me just make some extra (totally unnecessary) appointments to "use up" the credit. I told them I don't want to, and have asked repeatedly for the money to be refunded. Six weeks later -- with phones calls unreturned and ignored -- I'm at a loss as to how to get our money back. Any ideas?
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Old 02-08-2013, 05:16 PM   #9
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Quote:
Originally Posted by EagertobeinWDW View Post
We were overcharged on a copayment for an office visit. The provider admits we were over-charged, but simply refuses to refund our money. They tell me just make some extra (totally unnecessary) appointments to "use up" the credit. I told them I don't want to, and have asked repeatedly for the money to be refunded. Six weeks later -- with phones calls unreturned and ignored -- I'm at a loss as to how to get our money back. Any ideas?
Did you contact your insurance company to let them know about it? My situation hasn't gotten that far yet, but my insurance company said that once the medical office has been paid by the insurance company and the claim is complete, they will help me to get my copay refunded. Otherwise I will keep escalating my complaint all the way up to my state's Department of Insurance.
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Old 02-08-2013, 05:16 PM   #10
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In April 2012 I went for my annual physical and was charged $25. Didn't think much about it. In December I got a refund b/c there is no charge on my insurance for physicals. The attached paperwork said the refund was requested in May. Later that week I got a bill for the same amount. I called to follow up, and they said the bill was a mistake, but since I had them on the phone I asked why the refund took so long. They said that's how long a refund takes. I'm sure they would be very patient if someone told them they would pay them in 7 months.
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Old 02-08-2013, 05:18 PM   #11
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Quote:
Originally Posted by EagertobeinWDW View Post
We were overcharged on a copayment for an office visit. The provider admits we were over-charged, but simply refuses to refund our money. They tell me just make some extra (totally unnecessary) appointments to "use up" the credit. I told them I don't want to, and have asked repeatedly for the money to be refunded. Six weeks later -- with phones calls unreturned and ignored -- I'm at a loss as to how to get our money back. Any ideas?
Small claims court!
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Old 02-08-2013, 05:49 PM   #12
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Quote:
Originally Posted by EagertobeinWDW
We were overcharged on a copayment for an office visit. The provider admits we were over-charged, but simply refuses to refund our money. They tell me just make some extra (totally unnecessary) appointments to "use up" the credit. I told them I don't want to, and have asked repeatedly for the money to be refunded. Six weeks later -- with phones calls unreturned and ignored -- I'm at a loss as to how to get our money back. Any ideas?
You'll most likely get a response more quickly if you contact your state's dept of insurance/insurance commissioner. You should be able to find a contact number fairly easily on your state's website. Good luck!
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Old 02-08-2013, 08:29 PM   #13
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Quote:
Originally Posted by Shagley

Did you contact your insurance company to let them know about it? My situation hasn't gotten that far yet, but my insurance company said that once the medical office has been paid by the insurance company and the claim is complete, they will help me to get my copay refunded. Otherwise I will keep escalating my complaint all the way up to my state's Department of Insurance.
I agree with escalating to the state department of insurance but be aware if your policy is "self - funded" at your company the state department of insurance is not very helpful.

Our issue was in network versus out of network and the doctor was billing under a out of network tax id but listed on the insurance website under a in network tax id number. We verified the in network status several times prior to the visit (previous issues made us wary) but it did not good to verify since the office used two different tax id numbers.

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Old 02-08-2013, 09:33 PM   #14
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I agree with escalating to the state department of insurance but be aware if your policy is "self - funded" at your company the state department of insurance is not very helpful.

Our issue was in network versus out of network and the doctor was billing under a out of network tax id but listed on the insurance website under a in network tax id number. We verified the in network status several times prior to the visit (previous issues made us wary) but it did not good to verify since the office used two different tax id numbers.

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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.
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Old 02-09-2013, 10:16 AM   #15
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My GYno office tried to charge me a co-pay for my annual and when I reminded them that it was no co-pay for that, they said I must have talked to him about a problem and I told them I did not. She told me any problem questioned get marked as a second visit and they are allowed to charge for two visits then. I didn't let them do it since I had no problems that day. I had already been seeing that DR on many other appt's all around that day to schedule a procedure and it was never mentioned that day. I barely saw the DR at all, he did the annual and said, "See you next week." They dropped the charge.
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