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

[NiftyJ88]

I had this with DD's pediatrician. We took her for her 1 year well visit. During the exam, the dr. noticed an ear infection that was going away on its own. I was charged for a well visit and a sick visit. It was ridiculous. We haven't been back to the pediatrician since and only deal with my family doctor, part of a small privately owned practice.

 

[Leajess99]

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.

No, that does NOT sound right to me. I have recently done this with 2 of my kids and they only charged the insurance for one visit.

 

[Ava]

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.

Tell this to my doctor's office. I went in for a vaccine, which I assumed I would just get from a nurse & not even see the doctor. Nope, the doctor came in & talked to me for maybe 1 minute, they billed my insurance for an office visit & I had to pay the co-pay. He didn't even give me the information sheet about the vaccine or have me sign the consent form, the nurse did that when she came in to actually give me the shot. I was so annoyed.

 

[kelleyrn2000]

It seems there is alot of variance in the way drs offices bill.

I'm lucky that my ped doesn't charge for filling out forms, but it is done as part of a physical visit. We once made the mistake of scheduling dd's physical more than 90 days from the start of school, which made it invalid. So we had to take her back in for a separate appt, which insurance wouldn't cover because they had already covered her physical a few months prior. But I asked the ped if they could still do it and bill it as a sick visit, because she did have another medical issue that needed addressed (lovely plantars wart that he had to freeze off). They were fine with doing it that way, luckily.

I have heard of some offices billing for "vaccine education" which may or may not be done. That really ticks some people off! My ped office doesn't bill for that, but most of the education is in the form of a handout.

 

[Abbie]

If you have a procedure in the office (e.g. cyst drained or wart removed), there is no copay.

Why wouldn't you pay a copay for a visit like that? You will see the doctor and he/she will do the procedure (and procedures are booked for longer than a sick visit). You would be charged a copay for that kind of visit in every office I've ever known, including ours.

As far as the poster who had to pay for a visit for an immunization, could it have been that you hadn't been in for awhile? In my office, if you haven't been seen within the year, you will need a brief visit prior to getting a vaccine. Or maybe your insurance requires a copay for vaccines? I know some do.

 

[Nina]

I just had this happen recently. My ds went in for a well visit & an asthma check. I paid my $15 copay & about a month later got a bill for another. I called about it & they said it was 2 copays because he was there for 2 seperate things.

 

[PatMcDuck]

I work in a peds office.

Ava, I see you are from NY. Do you have GHI? Just curious. GHI (and perhaps some others) will NOT pay for any shots unless the PT sees the doctor. This causes headaches for the office, esp. in the fall when we are doing flu shots. So the Dr has to see the GHI shot patients, or the patients will have to pay the entire cost of "shot only" visits. This is in the GHI contract, we have no control over it, so to help the patients, we have the Dr see the GHI kids who need shots. It is crazy, our office has called and called about it, but this is just the way it is.... In NJ many patients want to split out the shots over multiple visits, we must charge a copay each time too. A few insurance companies now are balking at paying more only because parents want shots split up, so they want these patients to pay for the entire visit, if shots are split up for no medical reason.

We just recently began adding an additional office visit charge for kids who are sick during their well visits. We do not charge a double copay though. We add it to get extra $$ from the insurance for the well visit, that took more time because the child was sick. Keep in mind, primary doctors only get about $20-50 for office visits from the insurance companies, the rest is written off, unless the plan has a coinsurance % setup. This added code for the sick portion of the visit, gives the doctor only a small additional amount of $$. I will ask about that double copay thing though, I know we have never asked for that, even if a patient comes in the morning for one thing, and returns later the same day for something else (it happens).

And hey, we charge nothing for filling out forms, and we fill them out all day long, they take up an enormous amount of time. We also get nothing for filling out all the referral paperwork, letters of medical necessity, etc. We also do not charge for missed appointments, and do not charge a fee for people who fail to pay their copay the day of the appointment (and yes, we see the kids even if the parents fail to pay the copay upfront).

Working in a peds office is hard work! But the kids are so cute.

 

[taychase1015]

It depends on the health plan guidelnies and benefits on how the office copay is charged. Some plans assess the copay based on an E&M office visit code only. If an E&M visit is billed, the copay is applied. However, if only a lab, injection, or other non E&M visit is billed, a copay may not apply. Some plans base the copay on the place of service. If the member has any services in the office location, ie the lab, injection, E&M, a copay will be assessed. Normally, only one copay is assessed per a visit regardless of whether the provider billed a Sick visit alone, or billed a sick & preventative visit at the same time.

OP, please review your EOB and double check if two or one copay was assessed. If two copays were assessed, contact the insurance company and let them know you were only in for one visit. The second copay should be removed. If when you look at the EOB, it shows one copay was assessed, there may have been a charge for the filing of the claim, which would have been denied as an exclusion and that is what the provider is billing. You can contact the insurance carrier and ask them why you are being charged an additional $15. Depending on the carrier they may ask the provider for you, or they will refer you to the provider if they are unsure.

 

[disfan07]

I go into my doctors with more than one complaint. I went into my internist a few weeks ago about a sinus infection. While I was there, I talked to her about my stomach problems as well as some of my previous lab results (B12, Calcium, etc). We paid the $20 copay and only the $20 copay for that visit.

Foe my immunizations that I needed, I had to go in twice. Once for H1N1 and once for meningicocal and TdaP. Both times, it was a nurse visit but my doctor came in to talk to me during both visits. Never charged for it.

My internist charges for paperwork even if you give it to them at your appointment. They are really good at fillign it out quickly but it's like $15 for normal papers and $30 for other papers (I forgot exactly what they consider to be more expensive papers).

My specialists fill out forms for no charge.

 

[polkadotsuitcase]

I'd make a call, too. Even if they changed their policy and are charging for the physical, it would have avoided any surprises to let you know.

 

[Ava]

Ava, I see you are from NY. Do you have GHI? Just curious. GHI (and perhaps some others) will NOT pay for any shots unless the PT sees the doctor. This causes headaches for the office, esp. in the fall when we are doing flu shots. So the Dr has to see the GHI shot patients, or the patients will have to pay the entire cost of "shot only" visits. This is in the GHI contract, we have no control over it, so to help the patients, we have the Dr see the GHI kids who need shots. It is crazy, our office has called and called about it, but this is just the way it is....

No, I have United Healthcare. I'm not sure if they have a rule about a doctor seeing the patient in order to cover a vaccination; I did call to make sure they covered this vaccination for an adult & was told yes, but no mention was made of it having to be part of an office visit in order to be covered. It's only $15 so it's not really worth arguing about to me, I was just surprised I had to pay for an office visit just to get a shot that I didn't even need an appointment for. I go to a Beth Israel clinic that's largely walk-in, and when I called to try to make an appointment to get the shot I was told I didn't need an appointment for that & to just come in whenever.

 

[TandLMommy28]

Wow, that's crazy... my doctor's office doesn't even charge two co-pays if both kids come in with the same sickness.

 

[njmomtoone]

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.

Almost like what happened to me. Went for a physical (requires no co pay)> The doctor asked if everything was ok and I said well, now that you mention it my ear has been hurting on and off. She checked it and found it to be infected. I leave the office and get a bill in the mail for $35 co pay. I call the office and explain that there is no co pay for yearly physical and ws told they also billed the insurance co for a sick visit as well as a physical. Huh? Doesn't a physical require a doctor to look into a patients ears anyway?

 

[Avonlady1001]

I had this with DD's pediatrician. We took her for her 1 year well visit. During the exam, the dr. noticed an ear infection that was going away on its own. I was charged for a well visit and a sick visit. It was ridiculous. We haven't been back to the pediatrician since and only deal with my family doctor, part of a small privately owned practice.

Almost like what happened to me. Went for a physical (requires no co pay)> The doctor asked if everything was ok and I said well, now that you mention it my ear has been hurting on and off. She checked it and found it to be infected. I leave the office and get a bill in the mail for $35 co pay. I call the office and explain that there is no co pay for yearly physical and ws told they also billed the insurance co for a sick visit as well as a physical. Huh? Doesn't a physical require a doctor to look into a patients ears anyway?

Similar experience here. I took DS for his checkup (no copay) and mentioned that he spit up his milk on the way & I was concerned about his vaccinations & told her I wanted to hold them off for a few weeks, just in case he was coming down w/ something. She checked his ears & throat...hey his throat is red. Well, yes, he threw up 10 minutes ago. She agreed we'd hold his shots. Well, didn't I get a bill for the $20 copay for his sick visit!! She had to check his ears & throat at the checkup ANYWAY...he said she diagnosed my son. Um, excuse me?? LOL I don't think so! THEN, when I took him back for his shots (also no copay), doc checked his throat & tried to charge me $20 copay for a RECHECK VISIT!! I lost it & I wrote the letter of all letters to the head doctor about that it....They waived both copays...but this is becoming a habit with them.

They charged my insurance company for "surgery" which cost me $40 on top of the $20 copay...why? The doc used a q-tip to remove some wax...we were there for an ear infection. SURGERY?? Unfortunately, the ins agreed w/ them. They went inside her body. That's surgery. Lesson learned...if it happens again, give ME the damn qtip & I'll do it myself.

We are in the process of finding a new pediatrician. They do charge $10/year/child for paperwork, but it doesn't go through insurance. They just charge it.

 

[scarlet_ibis]

Ah yes, I did get a $300 copay bill for the "surgical" procedure of removing the packing after my sinus surgery. Seriously? That's not part of the whole $16,000 surgery? Any my OB charges a flat, non-reimbursible $25 for an in-office pregnancy test, which he requires before he'll start prenatal care. I think that's a little ridiculous, since I've already peed on a dozen little sticks by the time I get there.

Fortunately, there are some decent practicioners out there. My dentist doesn't even charge the copay.

 

[5forDiz]

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.

Not exactly your situation, but I think it is similar : DD had extensive blood work done at end of December as she had been experiencing glands in neck being enlarged on and off during that same month. Usually doctor will call or I will call on results, but when dr's office called, they asked that although all test results were negative, could we come in with her just to have neck rechecked. DH and I were fine with this and took her in, the physician's assistant ended up seeing her which we were okay with too, he took all of 1 minute checking out her neck and another minute reading aloud how all her test results were fine & also there were two students from one of the local college's pa program that were observing & that he was pointing things out to, etc. Total time ? under 4 minutes. Not that DH & I didn't expect to be billed for this office visit but we were surprised to see that they billed our insurance for a full well visit ; that imho seems excessive for services & time rendered especially since physician's assistant handled it & was educating students during this visit. While we do appreciate their wanting to have a look at DD's neck again, it did not, in our opinion add up to a full well visit. The doctor's office still has not replied to a written request we have made for an explanation on pricing, maybe they feel that we have health insurance so why should we care ? I really hate to take this up with our insurance provider because I just feel like that ultimately is going to lead to an awkward situation on our next visit, but I feel like this was an easy money grab on the practice's part.

 

[Tink-aholic]

Why wouldn't you pay a copay for a visit like that? You will see the doctor and he/she will do the procedure (and procedures are booked for longer than a sick visit). You would be charged a copay for that kind of visit in every office I've ever known, including ours.

As far as the poster who had to pay for a visit for an immunization, could it have been that you hadn't been in for awhile? In my office, if you haven't been seen within the year, you will need a brief visit prior to getting a vaccine. Or maybe your insurance requires a copay for vaccines? I know some do.

Because that is not an Evaluation and Management visit. Trust me, the doc gets far more money for that procedure than for a sick visit. Lots of people don't know this and pay anyway, and never check their EOBs to see if they should have. The last doctor I worked for had over $200K in unearned, uncredited copays on the books.