Doctors’ Offices Overcharging for Co-Pays

In the past few years, I’ve had interesting experiences at the numerous doctors’ offices I’ve visited while managing my and my daughter’s health. I’ve discovered that a number of times, we’ve been charged too much for a co-pay, or charged the co-pay in instances when one wasn’t necessary at that visit.

For us, a primary care visit merits a $20 co-pay; a specialist visit is usually $40. So If I see my primary care physician, it’s likely I have to cough up the 20 bucks; if it’s the endocrinologist, it’s $40.

Our health insurance company sends statements via mail every time it processes a claim, and it shows when a co-pay should — or shouldn’t — be charged for each particular visit. Thanks to these statements, I’d previously learned that my ob-gyn annual checkup is considered well-care, meaning there’s no co-pay payment required. And any other visits to the ob-gyn are only $20. But I’d been told to pay $40 per visit to this doctor, each time (excepting prenatal visits).

A few days ago, Baby Frugalista’s pediatric ophthalmologist sent us a check to return our last $40 co-pay — the follow-up visit didn’t necessitate another co-pay. Bless them — $40 is nothing to sneeze at! But I had to show my ob-gyn’s office staff that my visits there should only rate a $20 co-pay. They finally switched it, but I didn’t get a refund for overpaying a few times.

Don’t get me wrong — I’m grateful that we have good health insurance coverage at a (fairly) reasonable price. But you’d think the front-end staff would know when a co-pay applies, and when it doesn’t. Especially since we have a major health insurance carrier (Blue Cross Blue Shield).

Have you ever taken a look at your health insurance statements to see if you’re being overcharged for your co-pays?

5 comments to Doctors’ Offices Overcharging for Co-Pays

  • It is worthwhile to check doctors statements and other statements too. I never pay any doctor bills without the EOB from the insurance company.

  • Great post Penny, thank you.

  • Jessica

    You should demand a refund for your overpayments. There is no excuse for not refunding your money, no matter how old the claim. Not refunding them is insurance fraud. Get your EOBs and go demand the money back. I just demanded $20 back from an ob/gyn well care visit from January. They sent me a check. You can’t just let it slide because then the docs think they can get away with it. There are so many people who don’t check their EOBs and just get overcharged. You need to make a tizzy out of this so that the doc doesn’t go defrauding others.

  • […] worth of visits to doctors and specialists before getting pregnant — a LOT of $40 insurance co-pays. In addition to my ob-gyn, I was seeing an endocrinologist to keep my pre-existing thyroid disease […]

  • Winnie

    I had total 12 prenatal visits so far my Ob-gyn have had charged me co pay for 12 times also over charged me $20 each time. I called Blue Cross Blue Shield 2days ago they told me my copay is only$20 not $40. after bluecross blue shield called the doctors office they still tell us they need to check more about it. where can we report insurance fraud? my expecting day just end of next month. I really want to change another Ob-gyn.Not just for the money I felt that I lost many trust on them.

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