My copay for a specialist is $40 and PCP/GYN is $15. I had gone to a fertility clinic for IVF treatment and the clinic collected $40 each time, which is correct. However, my insurance EOBs show that the copay is only $15. For my insurance, all copays count towards my deductible and out of pocket max. So, it took me longer to meet both due to only $15 out of the $40 being counted.
I called insurance who said that the clinic put in the wrong billing code. The doctors provide both GYN and specialty services and per insurance, they put the service as GYN. I call the clinic and they say insurance is not reading / processing bills correctly. They always bill as specialists. Basically I am getting bounced back and forth between both entities. The clinic’s financial coordinator won’t refund me the difference and said something about me having to pay more out of pocket if I ask insurance to reprocess everything correctly because of the scheduling fees. If they count more of my copay (the extra $25) it would change the math and I’d end up owing more. Despite asking her to explain this to me multiple times, I could not understand why I would owe more.
I have limited knowledge of insurance. My understanding is that scheduling fees are contracted, allowed amount that an insurance would pay out for a service. I thought copays were separate from that. Is there anyone that can help explain why me asking insurance to reprocess the bills to reflect the $40 specialist copay would result in me paying more out of pocket? In my mind, I am just thinking that if things were calculated correctly, I would have hit my out of pocket sooner and insurance would have covered the remaining fertility treatments vs me having to pay 50% coinsurance for an additional period of time. Hoping I explained everything well!
submitted by /u/tba1437
[link] [comments]My copay for a specialist is $40 and PCP/GYN is $15. I had gone to a fertility clinic for IVF treatment and the clinic collected $40 each time, which is correct. However, my insurance EOBs show that the copay is only $15. For my insurance, all copays count towards my deductible and out of pocket max. So, it took me longer to meet both due to only $15 out of the $40 being counted. I called insurance who said that the clinic put in the wrong billing code. The doctors provide both GYN and specialty services and per insurance, they put the service as GYN. I call the clinic and they say insurance is not reading / processing bills correctly. They always bill as specialists. Basically I am getting bounced back and forth between both entities. The clinic’s financial coordinator won’t refund me the difference and said something about me having to pay more out of pocket if I ask insurance to reprocess everything correctly because of the scheduling fees. If they count more of my copay (the extra $25) it would change the math and I’d end up owing more. Despite asking her to explain this to me multiple times, I could not understand why I would owe more. I have limited knowledge of insurance. My understanding is that scheduling fees are contracted, allowed amount that an insurance would pay out for a service. I thought copays were separate from that. Is there anyone that can help explain why me asking insurance to reprocess the bills to reflect the $40 specialist copay would result in me paying more out of pocket? In my mind, I am just thinking that if things were calculated correctly, I would have hit my out of pocket sooner and insurance would have covered the remaining fertility treatments vs me having to pay 50% coinsurance for an additional period of time. Hoping I explained everything well! submitted by /u/tba1437 [link] [comments]Read Morer/HealthInsurance