Wiki Co-Pay being applied on pathology

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aleigh

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We have some claims that get processed with a 'co-pay' amount for pathology services we bill (88305,88307, etc) and leaving a co-pay (not co-insurance) of $20, $30, etc. to the patient.
This seems like an error on the insurance's end (we seem to only have this with Blue Shield), it was my understanding that co-pay's are only collected on office visits.
Has anyone else experience this?
Thank you.
 
Member's plan benefits

it would depend solely on the member's plan. The insurance company should be able to provide the summary of benefits for the service.
 
aleigh said:
These are all billed with POS 11.
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When I worked in primary care for 4 years, BCBS of Texas always applied a copay to the labs since they were billed with a place of service code 11. Most BCBS plans, including mine, state that any labs, x-rays, or certain diagnostics in office will be subject to a copay. Are the labs performed in-house or at a physician-owned lab? It sounds like you are billing the labs yourself. Are the labs done on a different day than the office visit?
 
mdsibley said:
When I worked in primary care for 4 years, BCBS of Texas always applied a copay to the labs since they were billed with a place of service code 11. Most BCBS plans, including mine, state that any labs, x-rays, or certain diagnostics in office will be subject to a copay. Are the labs performed in-house or at a physician-owned lab? It sounds like you are billing the labs yourself. Are the labs done on a different day than the office visit?
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Very interesting. Yes we are billing the labs ourselves, it's the same day as their office visit since we bill with the 'collection date'.
I have always instructed patients to call their insurance carrier if they feel it was in error. It just seemed weird to me.
 
aleigh said:
Very interesting. Yes we are billing the labs ourselves, it's the same day as their office visit since we bill with the 'collection date'.
I have always instructed patients to call their insurance carrier if they feel it was in error. It just seemed weird to me.
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Definitely check with their plan. Some plans out there have stackable co-pays, I saw it every day and patients are confused. The best way to remedy is to let patients know ahead of time that their plan may place an additional co-pay in error or that it is considered stackable, depending on their plan. I can't begin to tell you how many calls I would get for the same issue. BCBS seems to be the offender.
 
It's hard because we don't ever see the patient, but I will continue to advise anyone with questions to phone their member services line.
So many people just pay, wonder how many were processed in error. Yikes.
Thank you all for your help.
 
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