06/26/2020

Healthfirst Copays and Deductibles

Healthfirst is taking Double copays from Medicare Subscribers. The Podiatry Specialist Copay is $25.00. The regular Specialist copay is $45.00. We are being hit for both-- a 70.00 copay. HF says it's the Medicare Deductible, which it is not. Some subscribers would be way over the $198.00 and it's always $70.00, so the patient is NEVER meeting his or her deductible. #2. E&M codes, sometimes yes, sometimes No. We are billing correctly according to CMS.

Part 1: Healthfirst is taking double copays from Medicare Subscribers. (Healthfirst along with other insurances may charge a copay for an E&M and a copay for an additional procedure such as an X-Ray)

Part 2: The Podiatry Specialist Copay is $25.00. The regular Specialist copay is $45.00. (Need to see an EOB so I may respond accurately) We are being hit for both-- a 70.00 copay.

Part 3: HF says it's the Medicare Deductible, which it is not. (Patients need to meet their deductible first if they have Medicare primary and the EOB would state that) Some subscribers would be way over the $198.00 and it's always $70.00, so the patient is NEVER meeting his or her deductible.

Part 4: #2. E&M codes, sometimes yes, sometimes No. We are billing correctly according to CMS. Please provide an EOB from Health First showing how they are applying the above scenarios so we may decipher.