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Copay information

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c_townsley

Junior Member
What is the name of your state (only U.S.) Delaware
I had 28 appointments for physical therapy. I was never asked for a co-pay nor was I told there was a co-pay nor was there a co-pay requirement sign posted. Five months later I received a bill from the physical therapy company stating I owed them a co-pay payment for the past five months. Am I required to pay this? What do I do?
 


Proserpina

Senior Member
What is the name of your state (only U.S.) Delaware
I had 28 appointments for physical therapy. I was never asked for a co-pay nor was I told there was a co-pay nor was there a co-pay requirement sign posted. Five months later I received a bill from the physical therapy company stating I owed them a co-pay payment for the past five months. Am I required to pay this? What do I do?


Did you check with your insurance BEFORE you attended the appointments?
 

lealea1005

Senior Member
Some offices, especially if owned by a hospital or large corporation, do not permit an exchange of money on site. Instead of collecting at the time of service, they choose to bill the patient for co-pays/co-insurances/deductibles.

As stated previously, YOU are responsible for knowing what is covered and what your responsibilities are regarding your insurance policy.
 

barry1817

Senior Member
billing for time

What is the name of your state (only U.S.) Delaware
I had 28 appointments for physical therapy. I was never asked for a co-pay nor was I told there was a co-pay nor was there a co-pay requirement sign posted. Five months later I received a bill from the physical therapy company stating I owed them a co-pay payment for the past five months. Am I required to pay this? What do I do?
While other posted replies speak about you should know your coverage, I find it equally as important for an office to know what coverage they accept, what coverage that they don't, and not to give any impression that the fees for service are being covered, if there may be a copayment.

Having said that, this office never allowed you to shop for the best deal for yourself, and therefore did you a disservice.

You do have an obligation to pay, but I would recommend that you speak to someone and explain the situation, get a detailed accounting of your bill, and ask that allowances be made.

Personally, I am willing to bet that if you were told that there would be co-payments, and they didn't know exactly what was covered, you wouldn't even be asking this question.

I call it bad faith on the part of this provider to give the illusion, for 5 months, that you didn't owe anything and that the insurance was covering it all.
 

ecmst12

Senior Member
There is no shopping around! Copays are the same at every participating provider. That is the dumbest thing I've ever heard, how can you not know such a basic thing about how insurance works??
 
There is no shopping around! Copays are the same at every participating provider. That is the dumbest thing I've ever heard, how can you not know such a basic thing about how insurance works??
There was no sign & I never asked or investigated
 
Last edited by a moderator:

barry1817

Senior Member
There is no shopping around! Copays are the same at every participating provider. That is the dumbest thing I've ever heard, how can you not know such a basic thing about how insurance works??
excuse me for possible misstating. some doctors are in plans that have different payment schedules.

But in today's world, with programs, for a medical office not to inform a patient that the treatment isn't cover, to not explain that copayments may be necessary, that they are in the insurer's network or not, is wrong.

I know full well that with one of my doctors there is a fee when I get treated, insurance is billed and what is left is my responsiblity

I also know that one doctor that I see for treatment charges me one amount for each office visit, and another doctor, charges a different amount for each office visit.

Same insurance, different doctors, different fee for basic office visit each time.
 

cbg

I'm a Northern Girl
There are plans where the copay is different depending on whether you are seeing a PCP or a specialist. Which might be what you are finding.

But copays are set by the insurance policy, not by the doctor. It is a part of the insurance contract and is not negotiable. There is no "shopping around" - the copay is what the copay is.
 

c_townsley

Junior Member
I have an update on my co-pay problem and wanted to share it with all of you. I spoke with the billing department of the physical therapy company. I explained my situation, as Barry1817 suggested in his posting that I do. I explained to her I was not made aware of any co-pay. The physical therapy accountant reviewed all the paperwork I had signed prior to being seen by a therapist. She came to the realization that one form was missing…the form that stated I was responsible for any bills my insurance company did not pay, the form that stated there is co-pay which would be billed to me when the physical therapist released me from any more sessions. I was also told and as lealea1000 who was correct in her/his posting, this particular office does not permit an exchange of money. Due to the fact that I was not given a form to sign concerning any monies due after services were provided, I am released from any obligations. I would like to add that Barry1817 is correct. My insurance company does allow me “to shop” around. I did have a lesson learned moment though here by posting on this site-always ask. And to ecmst12, have you ever heard that no question is stupid? I find your response, and I quote you, “That is the dumbest thing I've ever heard, how can you not know such a basic thing about how insurance works??" demeaning and insulting to whomever it was directed. I guess we can’t all be as smart as you so in the future if you have something to say, raise your hand…then place it over your mouth; duct tape could be as effective as well or better yet, advise you might want to take…something I read and not sure who said it "Better to keep your mouth closed and be thought a fool than to open it and remove all doubt" :)
 

CSO286

Senior Member
I have an update on my co-pay problem and wanted to share it with all of you. I spoke with the billing department of the physical therapy company. I explained my situation, as Barry1817 suggested in his posting that I do. I explained to her I was not made aware of any co-pay. The physical therapy accountant reviewed all the paperwork I had signed prior to being seen by a therapist. She came to the realization that one form was missing…the form that stated I was responsible for any bills my insurance company did not pay, the form that stated there is co-pay which would be billed to me when the physical therapist released me from any more sessions. I was also told and as lealea1000 who was correct in her/his posting, this particular office does not permit an exchange of money. Due to the fact that I was not given a form to sign concerning any monies due after services were provided, I am released from any obligations. I would like to add that Barry1817 is correct. My insurance company does allow me “to shop” around. I did have a lesson learned moment though here by posting on this site-always ask. And to ecmst12, have you ever heard that no question is stupid? I find your response, and I quote you, “That is the dumbest thing I've ever heard, how can you not know such a basic thing about how insurance works??" demeaning and insulting to whomever it was directed. I guess we can’t all be as smart as you so in the future if you have something to say, raise your hand…then place it over your mouth; duct tape could be as effective as well or better yet, advise you might want to take…something I read and not sure who said it "Better to keep your mouth closed and be thought a fool than to open it and remove all doubt" :)
I want to address this line in particular--Just becasue there was a clerical error in the processing of your paperwork does not absolve you from paying the co-pays.

You still owe the money.
 

ecmst12

Senior Member
If the provider wishes to forgive the payment they are certainly allowed, but they were not required to. They were very kind.

Barry works in health care and should know better. Your copay is your copay no matter what participating provider you use, it is set based on what service you receive, not who provides it as long as they are in network. I was not implying that your question was dumb at all.
 

barry1817

Senior Member
billing for time

I have an update on my co-pay problem and wanted to share it with all of you. I spoke with the billing department of the physical therapy company. I explained my situation, as Barry1817 suggested in his posting that I do. I explained to her I was not made aware of any co-pay. The physical therapy accountant reviewed all the paperwork I had signed prior to being seen by a therapist. She came to the realization that one form was missing…the form that stated I was responsible for any bills my insurance company did not pay, the form that stated there is co-pay which would be billed to me when the physical therapist released me from any more sessions. I was also told and as lealea1000 who was correct in her/his posting, this particular office does not permit an exchange of money. Due to the fact that I was not given a form to sign concerning any monies due after services were provided, I am released from any obligations. I would like to add that Barry1817 is correct. My insurance company does allow me “to shop” around. I did have a lesson learned moment though here by posting on this site-always ask. And to ecmst12, have you ever heard that no question is stupid? I find your response, and I quote you, “That is the dumbest thing I've ever heard, how can you not know such a basic thing about how insurance works??" demeaning and insulting to whomever it was directed. I guess we can’t all be as smart as you so in the future if you have something to say, raise your hand…then place it over your mouth; duct tape could be as effective as well or better yet, advise you might want to take…something I read and not sure who said it "Better to keep your mouth closed and be thought a fool than to open it and remove all doubt" :)
thank you for taking the time, to follow up on some suggestions and to respond to those, and to respond as well to those that you found to less than responsive.

I do like your comment, about no question being stupid, and I have found that there are two responses to a question that someone deems "stupid". Either not respond, or respond politely.

I wish you the best,
 

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