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Old Feb 19, 2013, 04:08 AM
blur blur is offline
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Member Since: Apr 2011
Posts: 888
Quote:
Originally Posted by rainbow8 View Post
I agree it might be best not to bring it up with my T, but here's the way it looks on my Explanation of Benefits forms:

In one form Sept., 2012, amount charged is $150. The allowable charge was $129.50 and my coinsurance (copay) was $25.90. They paid her $103.60. It's been that way for 3 years. The one charge per visit.

Now, in 2013, they have 2 amounts for the same date.
Amount charged; $150.00, allowable charge $128.10, coinsurance $25.62, amount paid to her, $102.48.

Amount charged: $125.00, allowable charge $58.10, coinsurance $11.62, amount paid to her, $46.48.

Then it's added up to a total of $275.00, allowable charge of 186.20, copay 37.24 and amount paid $148.96.

I THINK my T charges $150 for 90 minutes. So, now she's getting $186.20 instead. I think I can ask to pay my former copay unless she raised her fee to $186.00. Does that make sense or not? She wouldn't charge a weird number like that! Her website says $125 for an hour, I think, but that's old. So I will ask her tomorrow if I get to it. I hate spending time on her fee!! My H wants me to pay her $2.00 since that would add up to $150. He's very logical, but of no help whatsoever. He also said to go back to one hour, that 90 minutes just means I can tell her "I love you" more. He, my H, can be so hurtful!!! He's mean and when I tell him that he doesn't understand. I make use of that extra 30 minutes and it would be hard to cut back to 60 minutes now.
rain, it sounds like your T may be submitting the charges so the allowable charges add up to ~$187.5 which is what 90 minutes would cost if she just billed it without insurance and going by her website hourly rate of $125 ($125 (hour) + $62.5 (half hour) = $187.5 (90 minutes)). her allowable charges 128.10 + 58.10 = $186.2. that is probably as close as she could get it to $187.5 without making the figures she put down for the amount charged sound weird and illogical like charging figures with cents. she probably started from the allowable charges and worked backwards to the amount charged to be able to get properly compensated according to her website hourly rate of $125.
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~ formerly bloom3
Thanks for this!
rainbow8