Author Topic: Two Separate Services, Two Co-pays, Same DOS  (Read 730 times)

Missjay

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Two Separate Services, Two Co-pays, Same DOS
« on: October 21, 2016, 01:46:14 PM »
I bill for ABA therapy and Speech therapy and I am having an issue with how to bill the patients co-pays. When I checked benefits I was told there is a $25.00 co-pay for both services but we are not to charge the patient both co-pays for the same DOS. They stated that only one co-pay will be applied to the patients OOP max. This is with UHC.
So my question is... What is best practice in this case? Do we bill the patient both co-pays regardless if only one applies to the OOP or are we as a company supposed to eat the other co-pay? Any help is greatly appreciated.

PMRNC

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Re: Two Separate Services, Two Co-pays, Same DOS
« Reply #1 on: October 21, 2016, 02:03:50 PM »
Is this for ONE carrier or does the patient have a secondary?
I have seen plans with co-pay tiers (Ie; copay for ov, labs, etc) So need more information on what type of plan this is if it's just one plan. Also what are the two services?

If they are only applying one co-pay, your not out anything as it stands to reason if they only take ONE co-pay that only one co-pay will be applied to patient's OOP max. That doesn't mean your office is out the other $25 copay if they don't take it.
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Michele

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Re: Two Separate Services, Two Co-pays, Same DOS
« Reply #2 on: October 21, 2016, 08:32:58 PM »
Is the provider contracted with UHC?  (in network?)  If they are in network and the insurance is stating that the patient is only responsible for one copay than you can only charge the patient the one copay.  If that is the case then the reimbursement should be accordingly.  Meaning that they should only apply one copay and the payment should include the total allowance for the second services.  For example:

UHC allows $75 for the ST, applies a $25 copay and pays $50
UHC allows $75 for the ABA, pays $75 since the copay was already applied to the ST
 
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