Author Topic: Aetna co-pays and allowed amounts  (Read 1491 times)

June

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Aetna co-pays and allowed amounts
« on: May 28, 2015, 12:36:00 PM »
Hello, I'm sure I have seen this answered before but I cannot locate it.  For Aetna chiropractic services we are contracted at a certain rate for each CPT code.  The two we use are 98941 for $45 and 98940 for $35, both for spinal manipulations but the first is for two regions, the second is for one.  My question is this:  The patient has a CPT code billed for 98941, we charge $45.00 the patient has a $40.00 co-pay.  The contracted rate for 98941 with Aetna is only 23.16, of which Aetna pays 3.16.  Wouldn't the co-pay we are allowed to charge only be $20.00 because the contracted rate is only $23.16.  I have spoken to several different Aetna representatives and have received different information.  I believe we can only charge the patient the contracted rate.  Is this correct?

barb2512

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Re: Aetna co-pays and allowed amounts
« Reply #1 on: May 28, 2015, 03:11:52 PM »
If the doctor/chiropractor/office has a contract with aetna you may only collect on the appt, from both the insurance and the patient, the allowed amount. Total allowed amount is all you may collect.
Barbara

June

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Re: Aetna co-pays and allowed amounts
« Reply #2 on: May 29, 2015, 12:02:58 PM »
Thank you, after talking with an Aetna representative that told me I should be collecting the $40.00 co-pay I started to question myself.  I knew I was processing it correctly!