General Category > General Questions

Co pay

(1/3) > >>

gderilus:
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:
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:

--- Quote from: gderilus on January 22, 2010, 05:20:13 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

--- End quote ---

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:
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:
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.

Navigation

[0] Message Index

[#] Next page