Quote:
Originally Posted by blueash
If Legacy is going to bill your insurance company for your care, they will be using standard CPT codes. There is a code for new patient visits and a code for established patient visits. The new patient code has a higher allowable and reimbursement to cover for the additional work of setting up your chart, introducing you to the office expectations etc.
When you get your EOB, explanation of benefits, for the visit, look at what code(s) were used. If a new patient code was used you were double billed and I would loudly complain to the insurance company about fraudulent coding as they have already been paid extra for your newness. I would also insist that Legacy refund your $119. You paid it with the expectation that your insurance company would refund you.
Now, I've never heard of an insurance company refunding to a patient for a covered service when the doctor participates and will be paid directly for the rest of the visit charge. If the charge were legitimate, then Legacy should include it in the claim they submit to your insurance and be paid the allowable by your insurance [after applicable copay etc] The fact that they insisted you pay and hope you'll get it back strikes me as proof they didn't expect the insurance to pay that charge.
Almost all insurance contracts with doctors include a paragraph that the patient is not responsible for non covered services unless you agree to that service. As you agreed to pay the 119 I don't think that prohibition would apply here.
Lastly, you apparently thought you had a chiropractic emergency. Was it worth 119 to get treatment? Did you get the relief you wanted?
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All true. Look at the EOB. If the CPT code was higher than 99203 they will have a hard time providing the appropriate documentation.
But "chiropractic emergency"? Isn't that an oxymoron?
