ER visit added office fee to bill

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donaldfair71
Posts: 538
Joined: Wed Mar 06, 2013 4:15 pm

ER visit added office fee to bill

Post by donaldfair71 » Wed Jul 31, 2019 3:29 pm

Hello All!

So I took my infant son to the ER recently. My insurance copay info is as follows:

ER $200
Specialist $35
PCP $20

I have been charged both an ER copay, as well as a specialist copay. Is this common? I reached out to the hospital, who said this is correct because a separate entity/ER provider uses the hospital at times. So it's the 200 plus that specialist fee for the outside group.

Does this make sense at all, and is this common? I am waiting to hear back from Anthem, but would like to know if this is just something that others have seen as well.

Broken Man 1999
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Re: ER visit added office fee to bill

Post by Broken Man 1999 » Wed Jul 31, 2019 3:45 pm

Seems right, maybe.

You took your son to ER. You probably saw a hospitalist who determined a specialists was needed.

My bill for ER had a hospitalist, and an orthopedic surgeon on the bill (along with X-rays taken and read).

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

runner3081
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Re: ER visit added office fee to bill

Post by runner3081 » Wed Jul 31, 2019 3:54 pm

donaldfair71 wrote:
Wed Jul 31, 2019 3:29 pm
I have been charged both an ER copay, as well as a specialist copay. Is this common? I reached out to the hospital, who said this is correct because a separate entity/ER provider uses the hospital at times. So it's the 200 plus that specialist fee for the outside group.

Does this make sense at all, and is this common?
Yes, a large number of ED physicians are not employed by the hospitals they work in.

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southerndoc
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Location: Atlanta

Re: ER visit added office fee to bill

Post by southerndoc » Wed Jul 31, 2019 4:12 pm

Is the ER copay the facility copay? Is the specialist the emergency physician?

Generally, the majority of ER physicians are contracted and will bill separately. Many hospitals interpret the Frank-Stark laws as not employing emergency physicians because it would be an anti-kickback for them to admit to a hospital who employs them. A bit stretched if you ask me, but I'm not an attorney.

Jim Beaux
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Joined: Sun Jul 23, 2017 4:29 pm

Re: ER visit added office fee to bill

Post by Jim Beaux » Wed Jul 31, 2019 4:25 pm

A few years ago I was admitted to a SE Texas hospital and the ER doc was a contractor who lived in Las Vegas. He rotated with other docs on a 2 weeks schedule. My insurance also wouldnt pay for the "out of network" labs (also on contract), until I fought with them & explained that there was no choice, as they were the in house lab for the hospital.

The insurance co will always assume the most profitable decision for itself. I suggest you call the insurance and tell them it was an emergency & you had no choice but to use what the hospital provided. Worked for me.

sawhorse
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Re: ER visit added office fee to bill

Post by sawhorse » Wed Jul 31, 2019 4:33 pm

I can understand the separate co-pay for the ER physician, but I'm stumped about the co-pay for the PCP.

Trader Joe
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Re: ER visit added office fee to bill

Post by Trader Joe » Wed Jul 31, 2019 5:07 pm

donaldfair71 wrote:
Wed Jul 31, 2019 3:29 pm
Hello All!

So I took my infant son to the ER recently. My insurance copay info is as follows:

ER $200
Specialist $35
PCP $20

I have been charged both an ER copay, as well as a specialist copay. Is this common? I reached out to the hospital, who said this is correct because a separate entity/ER provider uses the hospital at times. So it's the 200 plus that specialist fee for the outside group.

Does this make sense at all, and is this common? I am waiting to hear back from Anthem, but would like to know if this is just something that others have seen as well.
Yes this seems right to me.

sport
Posts: 8545
Joined: Tue Feb 27, 2007 3:26 pm
Location: Cleveland, OH

Re: ER visit added office fee to bill

Post by sport » Wed Jul 31, 2019 5:23 pm

My experience with a Medicare advantage plan is that there was one co-pay for the ER. The doctor billed separately, but there was no copay for her.

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SlowMovingInvestor
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Re: ER visit added office fee to bill

Post by SlowMovingInvestor » Wed Jul 31, 2019 5:29 pm

tbh, this seems like a pretty low co-pay for an ER visit to me.

CoastalWinds
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Re: ER visit added office fee to bill

Post by CoastalWinds » Wed Jul 31, 2019 5:33 pm

These are inexpensive ER costs. I wouldn’t worry about $35.

Topic Author
donaldfair71
Posts: 538
Joined: Wed Mar 06, 2013 4:15 pm

Re: ER visit added office fee to bill

Post by donaldfair71 » Wed Jul 31, 2019 5:49 pm

sawhorse wrote:
Wed Jul 31, 2019 4:33 pm
I can understand the separate co-pay for the ER physician, but I'm stumped about the co-pay for the PCP.
I was charged the cost of my ER copay and specialist. No PCP. I was just listing what my card says.

miamivice
Posts: 2196
Joined: Tue Jun 11, 2013 11:46 am

Re: ER visit added office fee to bill

Post by miamivice » Wed Jul 31, 2019 6:19 pm

donaldfair71 wrote:
Wed Jul 31, 2019 3:29 pm
Hello All!

So I took my infant son to the ER recently. My insurance copay info is as follows:

ER $200
Specialist $35
PCP $20

I have been charged both an ER copay, as well as a specialist copay. Is this common? I reached out to the hospital, who said this is correct because a separate entity/ER provider uses the hospital at times. So it's the 200 plus that specialist fee for the outside group.

Does this make sense at all, and is this common? I am waiting to hear back from Anthem, but would like to know if this is just something that others have seen as well.
The fastest and most accurate answer to your question is to message your insurance company and ask them. They can explain how your plan works and why this is correct. We do not know your plan, and are just guessing.

Scrapr
Posts: 330
Joined: Sun May 09, 2010 9:19 am

Re: ER visit added office fee to bill

Post by Scrapr » Wed Jul 31, 2019 6:24 pm

CoastalWinds wrote:
Wed Jul 31, 2019 5:33 pm
These are inexpensive ER costs. I wouldn’t worry about $35.
exactly.I always [assume] that an ER visit will be $1k. I am rarely wrong

[Edited by moderator oldcomputerguy]

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