Telemedicine Copay Issue

[scrabbler1]

I had a somewhat awkward situation the other day before the second of 2 telemedicine appointments I have had with different specialist doctors in the last few weeks.

The first telemedicine appointment went fine. I knew beforehand that my insurance company was waiving copays for all telemedicine appointments, so nobody asked me for any copay info or tried to bill me for it. It didn't matter if the appointment was related to COVID-19 or not. It didn't matter it the appointment was with a specialist or not. All that mattered was that the appointment was medically necessary, and both of them were. Both doctors I have been seeing for 5 years stemming from my 2015 hospital stay.

The second telemedicine appointment had the awkward moments. First, the doctor's staffer wanted to get credit card info for a copay. I told him the insurance company waived it. He replied with the COVID-19 requirement and I told him No. He replied with the specialist exception and again I told him No. Later, the doctor was on the phone with me and was claiming that I was costing him some money but he would still talk to me (it's not as bad as it sounds). He is a good man, often railing about insurance companies during my visits (which is fine, but where his ire should have been directed at the moment, not at me). I was a little miffed but the phone call went fine without further incident.

I do not believe he could refuse to talk to me because I correctly refused to give him a copay. If he has beef with my refusal, he should take it up with my insurance company, not with me.

Have any of you had any difficulties dealing with doctors where the copays have been waived by the insurance companies if there is a telemedicine appointment instead of an in-person one?

 

[COcheesehead]

I had a televisit appointment recently and was told my insurance would cover it including copay, but they asked for a credit card as back up. I gave it to them and didn’t have any issue.

I am not sure why you refused.

 

[Texas Proud]

I have had problems with copays before this pandemic... I just usually pay them as they are not that large... when the EOB arrives I get the money back.... at least the 2 times it happened.

 

[rodi]

Our insurance charged for both telemed appt's my son had back in March (before the legislature) My son had what we suspect was COVID - the first appt had the doctor looking at his throat with the phone camera held up, and then ordered strep tests. The 2nd appt cleared him to see an in person doctor - where they tested for flu. (He tested negative for both strep and flu and they refused to test for Covid because he hadn't been out of the country... this was early March.) As I said - we were charged for both phone appts and the lab tests and in person appt.

 

[youbet]

the copays have been waived by the insurance companies

I'm not sure what "waived" means in this context. Is the insurance company paying the doc an amount equal to what they contracted with him for the service plus the amount you would have paid as a copay so that his total compensation is unchanged? Or is the insurance company just saying that the doc will receive less compensation because they'll still only pay the contracted amount and they authorize you to pay nothing?

 

[scrabbler1]

I'm not sure what "waived" means in this context. Is the insurance company paying the doc an amount equal to what they contracted with him for the service plus the amount you would have paid as a copay so that his total compensation is unchanged? Or is the insurance company just saying that the doc will receive less compensation because they'll still only pay the contracted amount and they authorize you to pay nothing?

It's a good question. I don't know the answer, though. All I know is that I pay $0, which is why I refused to give the staffer my CC number. Why allow a copay I would definitely get back, then have to wait for the refund?

 

[RobbieB]

Because that is the correct procedure?

 

[youbet]

It's a good question. I don't know the answer, though. All I know is that I pay $0, which is why I refused to give the staffer my CC number. Why allow a copay I would definitely get back, then have to wait for the refund?

Well, just trying to think outside the box from the doc office point of view. If the doc is actually going to receive less money (neither you or the insurance company will pay the copay), then I guess he'll have to decide if he wants that business at that level of compensation or not.

 

[Golden sunsets]

We've done 1 telemedicine appt with a specialist already with a 2nd scheduled next week. The first did not mention money. The second hasn't yet. We do not normally have copays though. I would think that this would be taken care of before the appt and not involve the Dr.

 

[scrabbler1]

Well, just trying to think outside the box from the doc office point of view. If the doc is actually going to receive less money (neither you or the insurance company will pay the copay), then I guess he'll have to decide if he wants that business at that level of compensation or not.

Before the other telemedicine appointment, I had asked my insurance company if the copay schedule would be different from regular in-person visits because the level of service from a phone call is lower than an in-person one. Also, the cost of an in-person visit is more to the doctor, especially with COVID-19, because they don't have to clean and disinfect the waiting room and exam room, and it is safer for him and his staff to not have patients visit. So, wouldn't it be justified for the doctor to receive less?

 

[swakyaby]

Because that is the correct procedure?

+1

 

[Just_Steve]

During pre-COVID times I was only obligated to pay two co-pays per day on the times I have had three or more in one day I am required to pay the doctors office my co-pay and get any excess reimbursed by the insurance company.
So my assumption for waived co-pays would be pay and get reimbursed.

 

[Sunset]

I had a telemedicine appt with a specialist last week.
Mine was simply over the phone.

I wondered, since the service is crappy compared to an in office visit (no blood pressure test, no physical touch, cannot even see me, etc), the copay at $50 seemed like it would be fairly pricey for the service.

But they never asked for a co-pay, the entire appt took 8 minutes.

I think both sides benefited.

 

[WyomingLife]

I do not believe he could refuse to talk to me because I correctly refused to give him a copay. If he has beef with my refusal, he should take it up with my insurance company, not with me.

I believe anybody providing a service — from plumbers and electricians to doctors and lawyers — can decline to do so if payment isn’t clear. Doctors don’t work for free. My read of the fact pattern above is there is a dispute between the insurance company and its insured. I think the doctor could have said “hey, when you let me know how I am getting paid for this, we can proceed.”

Doctors do a lot of charitable things but I don’t understand the view that they should work for free. Indeed, medical professionals are incurring significant financial losses in these times (cancelled appointments, procedures). It isn’t a given your physician will still be in business in the months ahead.

 

[Lucie]

As a Specialist, I have been conducting 100% of my appointments through telehealth. While telehealth is mandated to be covered by all insurances during the Covid crisis, there is a lot of variability as to whether the co-pays are waived. (Waiving of the co-pays are not mandated.) One of the major insurance companies has indicated that co-insurance is waived, but it turns out that it is only for some of the plans, not all. I don't know until I receive the Explanation of Benefits. If I believe that it is waived, I tell my patients as such but that I can't guarantee it until I receive payment from the insurance company. I will bill them if there is a co-pay.

I would tell the office staff that it is your understanding that the co-pay is waived, but if it turns out to be different, they can bill you. At which point, they will see that it was waived. I don't expect them to know the rules for all of the insurance plans, but that should never be an issue in your care or your relationship with your doctor. That was very unprofessional for him to say that you were costing him money. Telehealth is required to pay the same rate as in person visits. (Although some MDs indicate that there may be a discrepancy between telephonic and video services.)

If the co-pay is waived, the doctors are receiving 100% of the contracted rate. The insurance company is paying the patient's share. They are receiving 100% reimbursement, so it actually works in their favor because they don't have to chase co-pays or write them off those who refuse to pay.

 

[scrabbler1]

I believe anybody providing a service — from plumbers and electricians to doctors and lawyers — can decline to do so if payment isn’t clear. Doctors don’t work for free. My read of the fact pattern above is there is a dispute between the insurance company and its insured. I think the doctor could have said “hey, when you let me know how I am getting paid for this, we can proceed.”

Doctors do a lot of charitable things but I don’t understand the view that they should work for free. Indeed, medical professionals are incurring significant financial losses in these times (cancelled appointments, procedures). It isn’t a given your physician will still be in business in the months ahead.

The doctor is getting paid. He is just getting less than he did otherwise, less by the amount of the copay. My refusal to pay the copay is saving me the trouble of showing him the EOB in a few weeks from now showing that my copay is zero and what I paid him should be refunded. I already know the copay will be zero, so why bother paying money I will be entitled to get back later? If there was some uncertainty about the copay being waived, I would pay it. But there is not.

 

[gwraigty]

Also, the cost of an in-person visit is more to the doctor, especially with COVID-19, because they don't have to clean and disinfect the waiting room and exam room, and it is safer for him and his staff to not have patients visit. So, wouldn't it be justified for the doctor to receive less?

The doctor is getting paid. He is just getting less than he did otherwise, less by the amount of the copay.

From the doctor's perspective, there are still fixed costs that need to be paid. Is the doctor getting a reduction in rent? Is the staff willing to take a reduction in pay? Are utilities costs going down? As long as the doctor still has enough in-person visits to attend to, it's not like he can vacate his current office and start working from home all of a sudden, or lay off 3/4 of his staff to reduce costs. This may not be the case with your doctor, but many doctors are actually employees in a multi-doctor practice vs. being self-employed. They have less flexibility to negotiate charges or bend the rules.

 

[scrabbler1]

From the doctor's perspective, there are still fixed costs that need to be paid. Is the doctor getting a reduction in rent? Is the staff willing to take a reduction in pay? Are utilities costs going down? As long as the doctor still has enough in-person visits to attend to, it's not like he can vacate his current office and start working from home all of a sudden, or lay off 3/4 of his staff to reduce costs. This may not be the case with your doctor, but many doctors are actually employees in a multi-doctor practice vs. being self-employed. They have less flexibility to negotiate charges or bend the rules.

The doctor is in a small practice, one or two other doctors including his wife. They are seeing no patients in person, only telemedicine ones. I spoke to only 2 staffer during all my calls. The calls all came from his office, unless he has some call-forwarding feature with his cell phone. I know his office has reduced its hours for the telemedicine calls, so some fixed costs have been reduced.

 

[scrabbler1]

The EOB arrives a few weeks later and it showed I owed a $25 copay, which I was willing to pay. But, strangely, a revised EOB arrived in June which eliminated the copay and had the IC paying $25 more instead. I don't know who was responsible for the revised EOB; I doubt it was the doctor given where we left off at the end of the telemedicine appointment. I haven't heard squat from the doctor since then, either.

 

[Kathe555]

If the co-pay is waived, the doctors are receiving 100% of the contracted rate. The insurance company is paying the patient's share. They are receiving 100% reimbursement, so it actually works in their favor because they don't have to chase co-pays or write them off those who refuse to pay.

I agree. Just because the insurance company is waiving the co-pays doesn't mean that the doctor is getting less money.

Sometimes doctors offices ask for things because it's their "procedure". For example, I never put my Social Security number on their forms. They don't need it. So if you don't feel comfortable giving them your credit card info, then don't. They can bill you if your insurance company doesn't pay.

 

[RetMD21]

The second telemedicine appointment had the awkward moments. First, the doctor's staffer wanted to get credit card info for a copay. I told him the insurance company waived it. He replied with the COVID-19 requirement and I told him No. He replied with the specialist exception and again I told him No. Later, the doctor was on the phone with me and was claiming that I was costing him some money but he would still talk to me

You were right, they were wrong. If anyone should feel awkward it should be the doctor and staff. Udually they are just guessing bout co=pays. You know more about your coverage.