Action News Troubleshooters: Copay confusion

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The world of healthcare and insurance can be complicated for patients to navigate. (WPVI)

The world of healthcare and insurance can be complicated for patients to navigate. And now, even the simplest of copays is causing confusion among a growing number of consumers.

The Action News Troubleshooters are trying to clarify some copay confusion.

More and more patients are getting charged a copay for an exam they think is free.

Andie Blizzard of Gloucester Township, New Jersey says for her annual GYN exam, there's usually no copay.

"Go in there, have your annual once a year, no copay," Andie said.

That is pretty standard.

But Andie received a bill for a $50 copay after her annual women's wellness exam in January.

"And I was totally blown away by that and confused," Andie said.

Andie's sister-in-law, Sharon Blizzard, has different insurance and went to a different doctor, but was billed $40 for her yearly wellness exam.

Sharon Blizzard says they billed her for a sick visit.

Their doctor's offices did give them an explanation.

"It's because you asked a question," Sharon said.

Yes, both women were charged a copay for asking a question outside of the realm of their wellness visit.

"I went, 'What? You're kidding me, right?'" Sharon said.

This was no joke. And it's happening to many patients.

Andie took to Facebook and was surprised by how many friends shared similar experiences with other doctors and insurance companies, some complaining about their children's pediatrician.

"That they are going for a wellness exam and being charged, it adds up, $50 here, $50 there, $50 here, and the bottom line is I'm paying a lot of money for my premium," Andie said.

No matter your doctor, no matter your insurance company, whether private or through the Affordable Care Act, this could happen to you.

"If you go into a more detailed conversation about a specific problem that may move the visit from more of a preventive one to a medical office visit," Dr. Raffi Terzian of HealthAdvocate said.

Andie and Sharon Blizzard were charged by two different Advocare clinics.

The company does have patients sign a form before wellness exams saying, "if an abnormality is encountered or a pre-existing problem is addressed...an additional office visit procedure will also be reported to your insurance carrier... you may be responsible for an additional copayment or deductible... we must conform to the realities of medical in today's environment. If we do not conform, we could be cited negatively by our insurers."

"I just don't think it's right," Sharon said.

"Or the doctor needs to be honest enough to stop you during the consultation and say you're stepping out of the realm," Andie said.

These women admit they didn't pay close attention to the form they signed, but also say they asked questions that took only seconds to answer and required no further testing, evaluation, or follow-up by their primary doctors.

"And now if you're going to start charging us in the back door, I have a problem with that," Andie said.

Andie Blizzard is concerned about the long-term health consequences she believes this could have on patients.

"If they think this may happen to them, they're not going to go to the doctor now and the whole point of this is to get women going and taking care of themselves," Andie said.

So what can you do?

"One of the things you can do is you can certainly contact your insurance company to understand how the bill was submitted," Dr. Terzian said.

But because different doctors and different clinics code very differently, it's also important you do call your doctor's office in advance of your wellness visit.

Sharon Blizzard says she'll still see her doctor, but will not just ask questions like before.
"Before I ask a question, I'm going to ask if I'm going to be charged for it," Sharon said.

It may not save you money, but at least it could save you from a surprise.

Also make sure you read any contracts or agreements you sign.

Advocare tells Action News its doctors don't think about coding, but simply how to provide the highest quality of care to its patients. It also says it will reevaluate the copays that Andie and Sharon were charged.

We're talking about all this on my Facebook page and hope you'll join in.

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