1 Dr's Visit + 2 Issues = 2 Co-Pays???

[Irin997]

Question for anyone in healthcare or with experience:

My DD9 had a doctor's visit a couple weeks ago and during the visit, we did a follow up with the dr about DD's ADHD and her meds as well as a physical for camp. I paid my $15 co-pay and off I went. The visit was no more than 15 minutes. I get a bill in the mail yesterday and the dr's office sent 2 separate claims to the insurance company so they are billing me $15, which seems like it is my co-pay. The whole reason I scheduled a single visit was so I wouldn't have to pay 2 co-pays. Does this sound right to you? I haven't had a chance to call the dr's office.

 

[SondraC]

Question for anyone in healthcare or with experience:

My DD9 had a doctor's visit a couple weeks ago and during the visit, we did a follow up with the dr about DD's ADHD and her meds as well as a physical for camp. I paid my $15 co-pay and off I went. The visit was no more than 15 minutes. I get a bill in the mail yesterday and the dr's office sent 2 separate claims to the insurance company so they are billing me $15, which seems like it is my co-pay. The whole reason I scheduled a single visit was so I wouldn't have to pay 2 co-pays. Does this sound right to you? I haven't had a chance to call the dr's office.

I have never heard of this one! I bring up many issues at appointments, and I have never had this happen!

 

[mickeylove2]

It's the physical form. They charge for that separately. It's something my dr. started last year, never had to pay a separate fee before but now it's $10.

 

[SondraC]

It's the physical form. They charge for that separately. It's something my dr. started last year, never had to pay a separate fee before but now it's $10.

Oh yes, I didn't think of that. I bet that is what it is.

 

[Irin997]

Wouldn't the doctor have told me that? They've filled out stuff for me before, no problem. And I just checked my EOB online and sure enough, one says $15 under co-pay that I may owe.

Hopefully they are open when I get home!

 

[maroo]

The doctor may not even know they are charging for it. Depending on the size of the office and how it is run - it could be charged by the person filing the claims.

It is so costly to the clinics to fill out the forms that many have started to charge for any form that is filled out.

 

[Mickeypooh99]

Our doctors office will fill out forms during any visit without charging extra, but if you need a form filled out without an appt. then you get charged the $10.00.

So my kids have had physicals at their well child visit close to their birthdays in December, but if we need a form filled out in the spring for sports then we have to pay for it.

 

[Mickeypooh99]

Also, we have never been charged 2 co pays when we have discussed 2 or more seperate issues in 1 appt.

 

[smokeyblue]

I'd call. That doesn't seem right. The camp physical form should had been filled out as a courtesey and the reason for the appointment should have been to assess/reasses the meds.

Did your insurance pay? I'd be suprised if they would pay both claims. It almost seems like fraud.

 

[mjkacmom]

I'd call. That doesn't seem right. The camp physical form should had been filled out as a courtesey and the reason for the appointment should have been to assess/reasses the meds.

Did your insurance pay? I'd be suprised if they would pay both claims. It almost seems like fraud.

Really? Our doctors have been charging $5 a form for years now.

 

[patsal]

I never call the Dr. I call the insurance right away and find out how it is being billed and then dispute it if I need to.

 

[Abbie]

I never call the Dr. I call the insurance right away and find out how it is being billed and then dispute it if I need to.

This is what I would do. It doesn't make sense that it was a fee for the form since it seemed to go through insurance as a separate claim.

Sounds like the DD had an actual physical, which is what the claim should have been submitted for. Addressing the med needs should not have been billed separately.

Which reminds me! In our office, if a patient is just seen for ADD meds, there's a very good chance insurance will not cover the visit at all. It goes through as "mental health" and often is not covered. So if you are due a visit to evaluate ADD meds, make sure the visit is also for something else like a physical.

 

[Firefly09]

The problem here is that insurance companies used to pay for multiple complaint visits. So you can go in one time with one co-pay and get everything done like a school physical, and routine medication refills. Remember, each thing takes time.

Now insurance will only pay for one complain per visit. So many offices will take the higher paying complaint and bill only for that and eat the cost of spending time doing everything else. While that might be very nice for the patient, it's not very good for the office to keep their books in the black. I have also heard of offices that will only address single complaints per visit and make patients schedule separate visits to cover other complaints or needs so that they can be properly reimbursed for the time spent addressing those complaints.

So I think the office should have alerted you beforehand that they would be charging you the extra fee but it was rather convenient that you were able to get everything done without having to have separate appointments. We'll be seeing more like this, requiring separate appointments for multiple complaints, as long as insurance keeps dictating what they will and won't pay for despite us paying the monthly premiums.

 

[tzolkin]

DH had a similar issue last year. He went in for a physical that he had scheduled months in advance and he happened to be sick (would not have gone to the dr. for the illness). When we got our bill, I noticed there were charges for two visits on the same day.

I called the insurance and they said one "visit" was for a physical and the other was a sick visit. I thought this was completely ridiculous, but they said it's now common practice to have multiple charges for one visit.

He complained to the billing office (he works at the hospital) because he had no intention of going to the dr. for his illness-- basically he had to pay double because he just happened to be sick that day. They did remove the charge.

 

[Mom2Ben02]

My ped's office has a sign on the counter that says there is an extra "office charge" for a Saturday visit of $30, which may not be covered by ins. It said they were allowed to do it based on "recent legislation" - i.e. Obama Care.

 

[descovy]

My dad uses the VA hospital/clinic for healthcare. For the past several years it has been "one issue per visit" and they're strict about it too.

You think you have it bad? Try being a 69 year old man with little issues cropping up all the time... and living 80 miles away from your assigned clinic!

Sounds like your doc may be doing something similar. Or too, it could be a "paperwork" fee. My kids' pedi doesn't charge for paperwork, but my own GP doc just started charging $15 in May (run's a family practice)

 

[scarlet_ibis]

My ped's office has a sign on the counter that says there is an extra "office charge" for a Saturday visit of $30, which may not be covered by ins. It said they were allowed to do it based on "recent legislation" - i.e. Obama Care.

Don't you dare blame Obama for that. I've been paying "after hours" charges for Saturday and evening office visits for years -- even though they have regular Saturday hours.

 

[Tink-aholic]

The problem here is that insurance companies used to pay for multiple complaint visits. So you can go in one time with one co-pay and get everything done like a school physical, and routine medication refills. Remember, each thing takes time.

Now insurance will only pay for one complain per visit. So many offices will take the higher paying complaint and bill only for that and eat the cost of spending time doing everything else. While that might be very nice for the patient, it's not very good for the office to keep their books in the black. I have also heard of offices that will only address single complaints per visit and make patients schedule separate visits to cover other complaints or needs so that they can be properly reimbursed for the time spent addressing those complaints.

So I think the office should have alerted you beforehand that they would be charging you the extra fee but it was rather convenient that you were able to get everything done without having to have separate appointments. We'll be seeing more like this, requiring separate appointments for multiple complaints, as long as insurance keeps dictating what they will and won't pay for despite us paying the monthly premiums.

This isn't actually correct. Coding regulations make it so that the copay is attached to the office visit, officially called an Evaluation and Management visit. There can be (and frequently are) multiple diagnoses connected to E&M visits (e.g. patient with high blood pressure, diabetes, and tobacco use disorder), but there is still only one "visit". If you go in for JUST a flu shot or to have your blood drawn for medication management, you pay no copay because no visit occurred. If you have a procedure in the office (e.g. cyst drained or wart removed), there is no copay.

If someone has multiple significant, separately identifiable reasons for the visit, current coding regulations prohibit charging two copayments for that visit. If the doctor wants two copays, he needs to set up a second appointment on another day. If routine medication management is discussed at an appointment for a physical, that should be included in the cost of the physical. If a new issue or illness is discovered during the physical, then the physical stops becoming a "routine" visit and has just become a "sick" visit -- and there is still only one copay.

There is nothing that prevents an office from charging for filling out forms, however.

I agree with patsal (HI patsal!) and suggest you call your insurance company. Don't pay the second copay until they direct you to do so.

 

[MickeyMomOfThree]

I'd have to call and ask about that one. When I take any of my DDs in, the doctor always asks about my other 2. If I have a questions or anything he answers it, no problem. If one of the kids has been in recently for anything he will ask about it, even if it isn't their appointment and they aren't there. He has even looked into the kids ears and throats when they were with me and a different DD was sick, just to be sure they wern't getting it too. The only time we were ever charged was once when one was in sick and he checked the little one and he said looked like she had strep, did the rapid and she did. He had to submit that to get the tests covered. No other times have we been charged.

As for medical forms, I really don't know if we get charged for extras. They give us one automatically (no charge) at their physical and I make copies so I have them through the year.

 

[cm8]

My ped's office has a sign on the counter that says there is an extra "office charge" for a Saturday visit of $30, which may not be covered by ins. It said they were allowed to do it based on "recent legislation" - i.e. Obama Care.[/QUOTE]