Insurance Company Rip-Off with Double Co-pays!

When we doctors submit claims to insurance companies for expectation of payment, we usually receive payment in around 6 weeks. The payment comes with an explanation of benefits (EOB). The EOB lists the doctors’ charges and details what was paid and what wasn’t paid, and gives explanations of denials.

This week we received an EOB from Keystone Health Plan East (an Independence Blue Cross HMO plan), which was denying payment on one date of service in question. They said that the patient actually owed two (yes two!) co-payments for the date of service in question. They said that their contract clearly stipulates that the patient has a $25.00 co-pay per condition.

Keystone said that since I had performed treatment on two separate conditions (two different areas), the patient was required to pay her $25.00 co-pay twice! This means that if I worked on the patient’s spinal areas (i.e. neck) as well as an extremity (i.e. the shoulder), the patient would be penalized. In effect, if you were being treated for a cough that led to back pain and a headache, Keystone would expect you to pay three co-pays!  I still can’t believe it.

Who would ever think that your insurance company would essentially break your body down into separate pieces, and then view each part as an individual person in regard to co-pays! This incident is unusual, however insurance companies seem to be masters of playing these types of games.

If something like this happens to you, I suggest immediately writing a letter of complaint to your insurance company and contacting your state insurance commission. In PA, the consumer advocate organization is The Pennsylvania Insurance Department at http://www.ins.state.pa.us/ins.

You can fight back.