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Application of CoPay

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  • chestnuthl@aol.com
    To the list What do you think about the paragraph below? Is it correct? do you have a contractual situation that illustrates either or both approaches? TIA
    Message 1 of 5 , Mar 4, 2005
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      To the list
      What do you think about the paragraph below? Is it correct? do you have a
      contractual situation that illustrates either or both approaches?

      TIA
      Cynthia Newby CPC


      Copayments began with HMOs, where the doc gets a set payment per enrolled
      member per month from the plan, and the patient pays additionally per visit or
      service. Today, private payers may require some form of copayment with the
      idea that this makes patients more careful about using medical services.
      Some health plans' copayments are the same for any visit; other health plans
      require different copayments for office visits vs surgical procedures vs lab
      tests.
      The application of a copayment depends on the contract the insured has with
      the payer. Some add them to what they pay the provider (if the fee is $120,
      the doc gets $120 from the payer and $20 from the patient), and others treat
      copayments as coinsurance-- a percentage of the fee--the fee is $120, so the
      payer pays $100 and the patient pays $20. It depends.



      [Non-text portions of this message have been removed]
    • Ingrid
      Cynthia: One thing I d like to clarify: copayments are fixed amounts that are due at the time of service for each visit to the doc & are noted on the insurance
      Message 2 of 5 , Mar 4, 2005
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        Cynthia:

        One thing I'd like to clarify: copayments are fixed amounts that are due at
        the time of service for each visit to the doc & are noted on the insurance
        card. This could be an HMO or PPO plan.

        Coinsurance is a variable because it is a % of the allowed amount. If you
        know what the allowed amount is, especially for your big payers, you can
        collect that at the time of service too.

        I've never heard of a copayment for a surgical procedure or labs, only
        coinsurance, although if a patient comes in for testing with the doc but no
        ov is charged, insurance will sometimes leave a copay on a procedure done in
        the office. In that instance, I'd collect it at the time of service for all
        patients in this scenario & refund after I see the EOB.

        Copays = fixed amount

        Coinsurance = % of X

        Ingrid Harrington
        The Billing Office
        ingrid@...
        (714) 241-6844 voice
        (714) 241-1319 fax
        (714) 329-0821 cell




        -----Original Message-----
        From: chestnuthl@... [mailto:chestnuthl@...]
        Sent: Friday, March 04, 2005 4:22 AM
        To: CRN-L@yahoogroups.com
        Subject: [CRN-L] Application of CoPay


        To the list
        What do you think about the paragraph below? Is it correct? do you have a
        contractual situation that illustrates either or both approaches?

        TIA
        Cynthia Newby CPC


        Copayments began with HMOs, where the doc gets a set payment per enrolled
        member per month from the plan, and the patient pays additionally per visit
        or service. Today, private payers may require some form of copayment with
        the idea that this makes patients more careful about using medical
        services.
        Some health plans' copayments are the same for any visit; other health
        plans require different copayments for office visits vs surgical procedures
        vs lab tests.
        The application of a copayment depends on the contract the insured has with
        the payer. Some add them to what they pay the provider (if the fee is
        $120, the doc gets $120 from the payer and $20 from the patient), and
        others treat copayments as coinsurance-- a percentage of the fee--the fee
        is $120, so the payer pays $100 and the patient pays $20. It depends.



        [Non-text portions of this message have been removed]



        ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
        CLICK ME LINKS:
        CodeCorrect 10% off for CRN Members when you sign up at
        http://crn.codecorrect.com 15% off for Gold Members - contact
        Laureen@... for details.

        Optimize physician service reimbursement compliantly:
        http://www.cfs-billing.com

        CEU TeleCourseTM Training & Videos
        http://www.crn-institute.com

        ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

        CRN Homepage:
        http://www.codingandreimbursement.net
        Become a CRN Gold Member!
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      • Chris Felthauser
        Ingrid; FYI....my personal insurance has a fixed copay of $200.00 for outpatient surgery. Any surgery I have is $200.00.....not to bad. So there are some
        Message 3 of 5 , Mar 4, 2005
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          Ingrid;

          FYI....my personal insurance has a fixed copay of $200.00 for outpatient
          surgery. Any surgery I have is $200.00.....not to bad.

          So there are some plans out there that do have copays for other services
          besides office visits.

          Chris

          -----Original Message-----
          From: Ingrid [mailto:INGRIDH@...]
          Sent: Friday, March 04, 2005 10:16 AM
          To: CRN-L@yahoogroups.com
          Subject: RE: [CRN-L] Application of CoPay


          Cynthia:

          One thing I'd like to clarify: copayments are fixed amounts that are due
          at
          the time of service for each visit to the doc & are noted on the
          insurance
          card. This could be an HMO or PPO plan.

          Coinsurance is a variable because it is a % of the allowed amount. If
          you
          know what the allowed amount is, especially for your big payers, you can
          collect that at the time of service too.

          I've never heard of a copayment for a surgical procedure or labs, only
          coinsurance, although if a patient comes in for testing with the doc but
          no
          ov is charged, insurance will sometimes leave a copay on a procedure
          done in
          the office. In that instance, I'd collect it at the time of service for
          all
          patients in this scenario & refund after I see the EOB.

          Copays = fixed amount

          Coinsurance = % of X

          Ingrid Harrington
          The Billing Office
          ingrid@...
          (714) 241-6844 voice
          (714) 241-1319 fax
          (714) 329-0821 cell




          -----Original Message-----
          From: chestnuthl@... [mailto:chestnuthl@...]
          Sent: Friday, March 04, 2005 4:22 AM
          To: CRN-L@yahoogroups.com
          Subject: [CRN-L] Application of CoPay


          To the list
          What do you think about the paragraph below? Is it correct? do you have
          a
          contractual situation that illustrates either or both approaches?

          TIA
          Cynthia Newby CPC


          Copayments began with HMOs, where the doc gets a set payment per
          enrolled
          member per month from the plan, and the patient pays additionally per
          visit
          or service. Today, private payers may require some form of copayment
          with
          the idea that this makes patients more careful about using medical
          services.
          Some health plans' copayments are the same for any visit; other health
          plans require different copayments for office visits vs surgical
          procedures
          vs lab tests.
          The application of a copayment depends on the contract the insured has
          with
          the payer. Some add them to what they pay the provider (if the fee is
          $120, the doc gets $120 from the payer and $20 from the patient), and
          others treat copayments as coinsurance-- a percentage of the fee--the
          fee
          is $120, so the payer pays $100 and the patient pays $20. It depends.



          [Non-text portions of this message have been removed]



          ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
          CLICK ME LINKS:
          CodeCorrect 10% off for CRN Members when you sign up at
          http://crn.codecorrect.com 15% off for Gold Members - contact
          Laureen@... for details.

          Optimize physician service reimbursement compliantly:
          http://www.cfs-billing.com

          CEU TeleCourseTM Training & Videos
          http://www.crn-institute.com

          ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

          CRN Homepage:
          http://www.codingandreimbursement.net
          Become a CRN Gold Member!
          http://www.codingandreimbursement.net/GoGold.htm
          Advertiser Options
          http://www.codingandreimbursement.net/advertising.htm

          ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

          Yahoo! Groups Links










          ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
          CLICK ME LINKS:
          CodeCorrect 10% off for CRN Members when you sign up at
          http://crn.codecorrect.com 15% off for Gold Members - contact
          Laureen@... for details.

          Optimize physician service reimbursement compliantly:
          http://www.cfs-billing.com

          CEU TeleCourseTM Training & Videos
          http://www.crn-institute.com

          ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

          CRN Homepage:
          http://www.codingandreimbursement.net
          Become a CRN Gold Member!
          http://www.codingandreimbursement.net/GoGold.htm
          Advertiser Options
          http://www.codingandreimbursement.net/advertising.htm

          ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

          Yahoo! Groups Links
        • Ingrid
          Chris: That s interesting. They sure are getting cheap, aren t they!!! You re right. I was just trying to clarify the difference between the terms copay &
          Message 4 of 5 , Mar 4, 2005
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            Chris:

            That's interesting. They sure are getting cheap, aren't they!!!

            You're right. I was just trying to clarify the difference between the terms
            copay & coinsurance. They are confusing & I have to explain this to
            patients all the time, don't you?



            Ingrid Harrington
            The Billing Office
            ingrid@...
            (714) 241-6844 voice
            (714) 241-1319 fax
            (714) 329-0821 cell



            -----Original Message-----
            From: Chris Felthauser [mailto:chrisf@...]
            Sent: Friday, March 04, 2005 10:25 AM
            To: CRN-L@yahoogroups.com
            Subject: RE: [CRN-L] Application of CoPay


            Ingrid;

            FYI....my personal insurance has a fixed copay of $200.00 for outpatient
            surgery. Any surgery I have is $200.00.....not to bad.

            So there are some plans out there that do have copays for other services
            besides office visits.

            Chris




            [Non-text portions of this message have been removed]
          • Chris Felthauser
            I know, it s such a foreign concept to patients. It always amazes me how so many people don t even know who their insurance is through, let alone what their
            Message 5 of 5 , Mar 4, 2005
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              I know, it's such a foreign concept to patients. It always amazes me
              how so many people don't even know who their insurance is through, let
              alone what their benefits are.

              Around here, we have so many people not understand the difference
              between medicare and Medicaid it's frightening. But I suppose that's
              what our job is, is to explain it to them.

              My parents don't even understand their insurances, I handle all that for
              them.

              -----Original Message-----
              From: Ingrid [mailto:INGRIDH@...]
              Sent: Friday, March 04, 2005 10:56 AM
              To: CRN-L@yahoogroups.com
              Subject: RE: [CRN-L] Application of CoPay


              Chris:

              That's interesting. They sure are getting cheap, aren't they!!!

              You're right. I was just trying to clarify the difference between the
              terms
              copay & coinsurance. They are confusing & I have to explain this to
              patients all the time, don't you?



              Ingrid Harrington
              The Billing Office
              ingrid@...
              (714) 241-6844 voice
              (714) 241-1319 fax
              (714) 329-0821 cell



              -----Original Message-----
              From: Chris Felthauser [mailto:chrisf@...]
              Sent: Friday, March 04, 2005 10:25 AM
              To: CRN-L@yahoogroups.com
              Subject: RE: [CRN-L] Application of CoPay


              Ingrid;

              FYI....my personal insurance has a fixed copay of $200.00 for outpatient
              surgery. Any surgery I have is $200.00.....not to bad.

              So there are some plans out there that do have copays for other services
              besides office visits.

              Chris




              [Non-text portions of this message have been removed]



              ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
              CLICK ME LINKS:
              CodeCorrect 10% off for CRN Members when you sign up at
              http://crn.codecorrect.com 15% off for Gold Members - contact
              Laureen@... for details.

              Optimize physician service reimbursement compliantly:
              http://www.cfs-billing.com

              CEU TeleCourseTM Training & Videos
              http://www.crn-institute.com

              ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

              CRN Homepage:
              http://www.codingandreimbursement.net
              Become a CRN Gold Member!
              http://www.codingandreimbursement.net/GoGold.htm
              Advertiser Options
              http://www.codingandreimbursement.net/advertising.htm

              ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

              Yahoo! Groups Links
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