Add On Charges Not Covered To 100% Covered Services

[Pip1948]

On the website they provide a summery of the visits, showing what is paid, what is denied, their idea of an EOB. At the bottom of each they show,Patients responsibility, and the one that is showing the denial of paying for the administration of the vaccine is on the same one as my office visit and they are showing only my copay for the office visit as patient responsibility.

I should have thought about looking at this? So, interesting that when I called the first time they seemed to think that I had to pay it??

 

[MBSC]

"...and they are showing only my copay for the office visit as patient responsibility."

That is the balance billing prohibition being enforced. It is also why I was wondering why the Customer Service Associate was having difficulty picking up on this.

It is true that many plans pay $0 for G0009 (administration) when an office visit is covered. But just because the plan pays $0 does NOT automatically mean the remainder is patient responsibility.

 

[Pip1948]

Well, I guess my doctors office thinks that it is, and my insurance company doesn't seem to be too sure about it, even though they show, only my office visit copay as members responsibility.

The other problem that I am having with this insurance that the person that called me back, kept talking about how long before the doctors office sent the bill to collections and that I should hear something back before then, but added that if I hadn't heard anything, I should call back. That is never a good sign! And that is 120 days, so I guess I shouldn't expect a prompt response??

You have bee so helpful, I really appreciate it. Thank you.