Any advice regarding odd, random co-pay bill from doctor

[nikki25]

from 4 years ago? Actually, there are 5 total co-pay amounts. The first amount of the statement was 3/2011 until 8/2012. I plan on calling tomorrow but was curious if anyone had a reasoning that I may be missing.Relevant facts are:

I still see this doctor every other month, sometimes every depending on my injection schedule- he is my pain management doctor.

I have been with the practice over 5 years.

I have had the same insurance for 9 years.

The only changes has been my copay amounts. When first hired I paid nothing. A couple years later it went to 5 ( primary)10 ( specialist), then 10/20 and two years ago when to 15/30. I have no yearly deductible to meet.

I NOW pay 30 co-pay for an office visit, nothing for my procedures, which would have not been the same copay 4 years ago which is also odd.

Nothing has ever been said regarding a potential past due amount, like, ever.

I have always paid my co-pay on spot.

Lastly, the total bill is 150 for alleged lack of copays from 2011-2012.

Am I missing something? Nothing of this makes sense.

Thanks.

[captainobvious]

Call your insurance company and ask to provide an Explanation of Benefits (EOB) for each service date. That should tell you if a co-pay was already applied.

[midnightmare81]

Apr 26, 2015 18:51:27 GMT -5 captainobvious said:

Call your insurance company and ask to provide an Explanation of Benefits (EOB) for each service date. That should tell you if a co-pay was already applied.

I don't know about her insurance company per say but we don't have any info on payments made or not made by the pt to the doctor. They should be able to tell you what you would owe for those dates but not likely if it was paid or not.

[frannyr]

Don't pay.

Your insurance company would not pay claims this old if they were billed now. Claims are usually denied if they are submitted a year or more after the date of service for not meeting timely filing.

The office may forgive this by now. Is it possible they have some claims they never filed or got reimbursed for from your insurance company so they are trying to collect from you?

[captainobvious]

Apr 26, 2015 19:26:29 GMT -5 midnightmare81 said:

Apr 26, 2015 18:51:27 GMT -5 captainobvious said:

Call your insurance company and ask to provide an Explanation of Benefits (EOB) for each service date. That should tell you if a co-pay was already applied.

I don't know about her insurance company per say but we don't have any info on payments made or not made by the pt to the doctor. They should be able to tell you what you would owe for those dates but not likely if it was paid or not.

Huh, our EOBs list that all out, along with an approximate amount owed. Guess they're all different, but it couldn't hurt to check.

[midnightmare81]

Apr 26, 2015 20:20:52 GMT -5 captainobvious said:

Apr 26, 2015 19:26:29 GMT -5 midnightmare81 said:

I don't know about her insurance company per say but we don't have any info on payments made or not made by the pt to the doctor. They should be able to tell you what you would owe for those dates but not likely if it was paid or not.

Huh, our EOBs list that all out, along with an approximate amount owed. Guess they're all different, but it couldn't hurt to check.

Checking is always a good idea! Just wanted to mention it since we get that question a lot. Most often it's older people who are upset because they think it's a bill they have to pay to us (even though it says "this is not a bill" right on the EOB) after they have already paid the doctor before they left the office. We just explain to them that we are simply letting them know what their portion is. The money that shows owed does not come to us, it's the offices money. We only know what we paid the doctor and the pt's portion of the bill, not if, when or how much the pt already paid of their portion.

[midnightmare81]

TBH I have never actually seen a claim that mentions any payments made by the patient.

[nikki25]

Apr 26, 2015 18:49:33 GMT -5 @beagle said:

How do you pay? Cash? Check? CC? Do you get receipts at each visit? I'd ask for a list of every visit and charge and co pay. Methinks the billing department messed up.

Usually credit/debit card or our HSA credit card thingy. It probably is just a screw up but it is odd. I wonder if they are claiming I owe a co-pay for my 'procedures' aka injections.

[nikki25]

Apr 26, 2015 19:26:29 GMT -5 midnightmare81 said:

Apr 26, 2015 18:51:27 GMT -5 captainobvious said:

Call your insurance company and ask to provide an Explanation of Benefits (EOB) for each service date. That should tell you if a co-pay was already applied.

I don't know about her insurance company per say but we don't have any info on payments made or not made by the pt to the doctor. They should be able to tell you what you would owe for those dates but not likely if it was paid or not.

Yeah, I don't know if IBX would have those paid records besides stating what my co-pay is but it is definitely worth a call.

I could understand if I stopped using this particular doctor years ago but I am there all.the.time and nothing was ever mentioned, leading me to lean towards an error.

Thanks for both of your insights!

[nikki25]

Apr 26, 2015 19:43:40 GMT -5 frannyr said:

Don't pay.

Your insurance company would not pay claims this old if they were billed now. Claims are usually denied if they are submitted a year or more after the date of service for not meeting timely filing.

The office may forgive this by now. Is it possible they have some claims they never filed or got reimbursed for from your insurance company so they are trying to collect from you?

Thanks.

I don't think it has anything to do with the insurance denying payment, well, I don't think so anyway, who knows. But, it sounds like the office is claiming I didn't pay my copay. But, my copay in 2011-2013 was lower for specialists. Maybe the office manager was auditing uncollected copays or something? Then basing the copay on the present not the past. 

 I am definitely not paying anything until I can get the situation hopefully resolved.