Author Topic: Co pay  (Read 2552 times)

gderilus

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Co pay
« on: January 22, 2010, 02:20:13 PM »
I'm very confused about how the copay work and co insurance. If a patient has a $40 copay and they pay it at the time of service. let say you bill cigna $60 for 90806, then cigna pays their 80% and the 20% left is still the patient's responsibility right. The patient has to pay the copay at the time of service plus the co insurance after cigna has paid its portion right. Am I correct or no

I'm new to billing and have a lot of questions

redeyecherry

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Re: Co pay
« Reply #1 on: January 22, 2010, 05:14:35 PM »
Well the patient has to pay if he only has a primary insurance.
If the primary insurance doesnt cover it 100% (and doesnt write everything off) either its the patients responsibility or you have to forward it to the possible secondary insurance.
It usually tells you on the EOBs what the patients responsibility is - if he/she doesnt have a secondary insurance.

Pay_My_Claims

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Re: Co pay
« Reply #2 on: January 22, 2010, 06:37:02 PM »
I'm very confused about how the copay work and co insurance. If a patient has a $40 copay and they pay it at the time of service. let say you bill cigna $60 for 90806, then cigna pays their 80% and the 20% left is still the patient's responsibility right. The patient has to pay the copay at the time of service plus the co insurance after cigna has paid its portion right. Am I correct or no

I'm new to billing and have a lot of questions

It depends on the service and the plan the client has. The client can have a deductible, copay, and coinsurance that all applies to that service. You have to verify his benefits first. Like my son has no copay, just a deductible of 200 with cigna then they pay 85% ucr, however when he goes for his physical it is no copay and paid at 100% ucr.

NuBiker

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Re: Co pay
« Reply #3 on: January 22, 2010, 07:18:00 PM »
hi gderilus!!!

90806??? Hey - do you work in the mental health field?
Seems all I ever use is 90801, or 90806.
My wife is a psychologist in private practice, and I do her billing for her.
What I do is when I get a new patient, I get their name, ins company, id number, and date of birth.
Then I go online and print out their benefits.
Then, after I think I know what their copay is, I phone the insurance company to verify if I got it correct.
Also, I email the new patient, and tell them what their copay is, along with a disclaimer saying the information might not be correct, that this is what we charge until we get the first EOB (Explanation Of Benefits), usually about 3 weeks later.
Whatever the EOB says will be their copay.
8 out of ten times the copay information is correct. Sometimes it's not, because of what Pay_My_Claims says.
I have been doing billing since March 2009. I am still stumbling around.
I get frustrated because each insurance company can be just a little bit different in how they process the claims.

Best Regards,
Nu

gderilus

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Re: Co pay
« Reply #4 on: January 23, 2010, 12:38:13 PM »
Yes, I work in the mental health field. I'm very new to billing and I think it's getting a little easier for me to bill and understand the mental health field. Claims are getting easier for me to send since I mostly bill for returning patients weekly.

kwardbilling

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Re: Co pay
« Reply #5 on: January 24, 2010, 11:58:25 AM »
I'm also in the mental health billing field, and I do the same.  Call to verify information for copays etc I bill the patient if they don't pay their copay at their visit, and stipulate that if it's different because of co insurances etc. we will re-bill the remaining balance.  Most times it's a set copay, but I'm finding lately their are more co-insurances.  Again,  I defnitley check the EOB for Patient Responsiblity.  I've been doing mental health billing for 3 years.  What state are you from?  I'm from MA

NuBiker

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Re: Co pay
« Reply #6 on: January 24, 2010, 11:54:52 PM »
I'm in Southern California - about 30 miles east of Los Angeles.
About 80 per cent of our patients are Blue Cross. Effective January 2010, their computer somehow mistakenly changed a whole bunch of patients to capitation. I have been getting form letters stating BX won't pay, to send the HCFA to a private medical group. I phoned BX, and they figured out the problem right away, and corrected it, but said my payments might not show up for 30-45 days. Ouch!!!
I am gonna have to get a cash advance on the boss' credit card to pay the office lease.
Has that ever happened to anyone else here?
Nu

kwardbilling

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Re: Co pay
« Reply #7 on: January 25, 2010, 08:13:21 AM »
no, but I had a weird thing happen with BCBS this past month.  With one of my counselors they put a hold on the account saying that something had been returned to them as undeliverable so they thought she was no longer at.  Nothing had changed, she never moved etc, so I called BCBS and they took the hold off her account, meanwhile, quite a few claims came back as denied because of address and I needed to re-submit, which had delayed her payments for this past cycle.  (LOL, they probably mailed her something incorrectly i.e. not enough postage or something)..anyway seems to be all set now.

PMRNC

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Re: Co pay
« Reply #8 on: January 26, 2010, 11:57:43 AM »
If you are billing mental health (or any specialty for that matter) it's best not to stumble at all. I suggest taking a course and getting yourself educated. You will not only be seeing more "coinsurance" but you will also be seeing denials stating "No mental health benefits" due to the new parity laws that took effect in 2010. Groups of 50 or more will have the ability to drop mental health benefits upon group renewal dates or open enrollment dates. Or you might also see that there is no more 50% plans, no limits on benefits, etc. In doing verifications as of 1/1/2010 it's suggested you get the group renewal date so you can inform the patient that upon that date they will need to find out if their group will be extending or deleting mental health benefits. These new federal parity laws were supposed to be put in place to make mental health benefits "FAIR" however the insurance companies have to make up for the loss by increasing premiums and employers are finding they can't or won't pay the premium increase.
While the basics of billing are sometimes learned by hands on.. it's federal and state regulations that you can't afford to "stumble" through.
Linda Walker
Practice Managers Resource & Networking Community
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www.billerswebsite.com

NuBiker

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Re: Co pay
« Reply #9 on: January 26, 2010, 11:27:16 PM »
I have been through two billing courses, but still lack confidence. Some days I feel like I am reinventing the wheel, LOL.
I think what saves me, is we only have about 50 patients at any one time. So most of the work is repetitive.
I always seem to have three accounts that are behind - the insurance company is late in reimbursing us.

Michele

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Re: Co pay
« Reply #10 on: January 27, 2010, 06:05:18 AM »
No one has 100% payment rate, so that's not bad.  The key is that you are going after the ones not paid, and not letting them slip thru the cracks.

Michele
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PMRNC

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Re: Co pay
« Reply #11 on: January 27, 2010, 02:16:11 PM »
Ok, so BUILD your confidence. How do you do that.. by SHOWING OFF and acting the opposite. A newsletter, a blog, discussions, calls, networking.. get out there and BE the expert. You have to have confidence in what you do and to get confidence you need to put yourself out there and become an expert :) With three clients (regardless of size) you have a head start, use it!
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com