Why have I been charged for other services associated with a specialist visit when I was referred by my primary care physician and paid the $30 office visit co-payment?
A. Your $30 co-payment has paid for the office visit consultation. Any procedures or manipulations performed in the office visit setting are not covered by the office visit co-payment. The charges for these ancillary services will first be applied to your annual deductible, and then paid at 90% if you received a referral, or paid at 70% if you self-referred to the specialist. Q. My claims seem to be paid incorrectly. When I receive preventive care services, my claims are not paid at 100%. I pay the office co-payment, but then I receive bills from the provider. Why is this happening? A. Many claim problems are the result of incorrect bills submitted by the providers. At the time you receive services, the doctor’s office determines how your health insurance claims will be submitted for payment: they are either coded as preventive services or coded with a diagnosis code. Inaccuracy in coding by doctors’ offices can cause claims to be processed incorrectly. Due to new privacy laws, Anthem
