Am I responsible for multiple insureance copays for the same emergency room visit?

Question

i have an Aetna health insurance plan that requires a $50 copay for emergency room visits, which I paid when I was in an accident and needed stitches. Now Aetna claims I am responsible for an additional $150 copay for a surgical procedure. Does this double-copay make sense?

Answer 1

Possibly. For example, if I went to the ER, I'd have to pay a copay for the ER visit and then another for x-rays. It depends on the terms of your insurance. This particular surgical procedure falls under another copay, though that seems kinda dumb to me. I'd call them, just to be sure it wasn't an error.

Answer 2

I agree with Suzanne. Sometimes, the ER copay is waived when admission occurs from the ER. It sounds, however, that this was a procedure that was completed in the ER. You should have received an "Outline of Coverage" from Aetna, defining your responsiblilty in this situation. If the $50 copay includes all procedures associated with the ER visit, then there could have been a billing error. If it separates the ER services and physician services, you could be liable for both. Read the "Outline", and if questions still exist, take 2 aspirin and call me in the morning. I mean, contact your agent or human resources department.

Answer 3

Possibly. Some Aetna plans have different copays for office/er visits, and a separate ones for procedures or tests.

Call and ask if the sutures were bundled into the visit or if it's a separate billable.

Answer 4

It depends upon the terms of the contract covering you. In my case, I have a $50. ER co-pay and a $50. ER physician co-pay; both are waived in the event I am hospitalized. If you were admitted through the ER, it may very well be that Aetna should have waived your co-pay. In that event, you need to send Aetna a written appeal.