General Category > General Questions

Copays

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DMK:
Just chiming in....if the Doctor is charging for an office visit it's my understanding you HAVE to charge the Co-pay.  If the visit goes to the patient's deductible, you would have to collect the deductible.  A CHARGED for visit is a visit you have to charge for!  I would hope that the visit is charged for appropriately too.  I can't stand seeing a doctor charge for a detailed visit (99214 or 215) when he spent 2 minutes.  The detailed visit would have been the 1st visit (99215), and the follow up should be a minimal (99212).  The co-pay is the same for both, but the reimbursement is different, if the visit goes to the patient's deductible the second visit would be less than the first visit.

rdmoore2003:
i think it may also depend on the dx code.   for instance, my son has blue cross and went to dr for appt was charged like a 99213 we paid his copay.  that was done correct.   then 2 weeks later we went for a f/u.    claim was sent to insurance as 99212 but dx code was a v code used as a f/u visit.  per my eob, dr was reimbursed for 99212 but due to dx I was not responsible for copay on f/u visit.     this has happened many times with my family and in different dr offices that i have seen.   Are the insurance companies doing this wrong????

DMK:
That's excellent, and good to know for the future!

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