Hi,
I am rather new to the USA, so I’m not entirely sure if there is something odd going on with a provider, or if I am just misunderstanding the system.
I live in NY state. My teenage daughter is a dependent on my insurance plan. She is seeing a counsellor, who is either a trainee or is newly qualified, and is under the supervision of an in-network provider (a psychologist). We pay the counsellor, directly, $20 per visit as a co-pay (though a cash transfer app). The supervising provider then bills the insurance company for $200 for “cognitive services”. They pay out $95.
According to the Explanation of Benefits for these claims, there is no payment due by us (we have no deductible or co-insurance for in-network providers, just a $20 co-pay that we normally pay for specialists).
Is it normal for the co-pay not to appear on the EOB? It is shown under “Your Responsibility” on EOBs that we have had for visits to other physicians, which we have just paid at the time of the visit. Is there some odd quirk relating to counsellors/psychologists that I don’t understand? Should they not have been charging a co-pay then billing the full amount to the insurance company? Or is something else going on?
I don’t really want to raise this with the insurance company or the provider in case we trigger some kind of process, and it ends up damaging the relationship with the counsellor. But if it is shady, then that is different… I’d be grateful if anyone could provide any clarity.
Thanks.
submitted by /u/Technical_Piglet_979
[link] [comments]
Hi, I am rather new to the USA, so I’m not entirely sure if there is something odd going on with a provider, or if I am just misunderstanding the system. I live in NY state. My teenage daughter is a dependent on my insurance plan. She is seeing a counsellor, who is either a trainee or is newly qualified, and is under the supervision of an in-network provider (a psychologist). We pay the counsellor, directly, $20 per visit as a co-pay (though a cash transfer app). The supervising provider then bills the insurance company for $200 for “cognitive services”. They pay out $95. According to the Explanation of Benefits for these claims, there is no payment due by us (we have no deductible or co-insurance for in-network providers, just a $20 co-pay that we normally pay for specialists). Is it normal for the co-pay not to appear on the EOB? It is shown under “Your Responsibility” on EOBs that we have had for visits to other physicians, which we have just paid at the time of the visit. Is there some odd quirk relating to counsellors/psychologists that I don’t understand? Should they not have been charging a co-pay then billing the full amount to the insurance company? Or is something else going on? I don’t really want to raise this with the insurance company or the provider in case we trigger some kind of process, and it ends up damaging the relationship with the counsellor. But if it is shady, then that is different… I’d be grateful if anyone could provide any clarity. Thanks.
submitted by /u/Technical_Piglet_979 [link] [comments]Read Morer/HealthInsurance