After appeal: Copay does not apply to "Office Visit"
I went to an in-network dermatologist for a skin check, and she zapped some spots with liquid nitrogen. The EOB lists an Office Visit procedure code 99213, and a Cell Destruction procedure code. My copay was not applied to any line, and all approved costs were assigned to deductible. Does that seem right? Insurance company paid nothing at all, and I am told I am responsible for $800. For at least the Office Visit line, I would expect the insurance company to pay all but the copay. The EOB has a column for "Your copay", and it was left blank. The "amount billed" is $1300, the "member rate" is $800, and "my share" is $800.
One insurer phone rep said it was a mistake, and would be re-processed, but nothing changed. A second phone rep said they applied the "highest level of benefit" (but you paid nothing!) After a written appeal, nothing changed, but they have no explanation why a copay does not apply. Does that seem correct? Or am I wrong and it is expected that office visit copays don't apply if there is also a procedure during the office visit. In the past I have paid a copay plus the deductible cost of the procedure, and the insurer paid the balance of the Office Visit charge.
submitted by /u/IKnowUrNotMyDoctor
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