Eye Med & Aetna confusion on patient co pay...

[Uncle Fester]

So what's the co pay for exams- especially for Aetna Eye Med?

If bringing up one authorization isn't enough we're now told we have to acquire a second under their group number to determine final charges including co-pays.

Okay- so be it. But when the first authorization has a $10 co pay and the second (group auth.) has a $42 amount how do you know what to charge?



At least the second group based authorization lets me know if a complete pair is required for the full discount as opposed to only 20% for lenses only but yeash- you'd think it could be done on only one (the first) printout!!!

[Uncle Fester]

But wait! There's more!!

The receptionist in the above example pulled the group authorization without recognizing the benefit number did not match the original. The correct authorization co-pay is $65.

At least for now.

[drk]

Fes, if using the EyeMed benefit, the copay should be cut and dried.

If using the Aetna, the copay could be anywhere on the map.

What's the procedure code?

[Uncle Fester]

Fes, if using the EyeMed benefit, the copay should be cut and dried.

If using the Aetna, the copay could be anywhere on the map.

What's the procedure code?

I'm told they're 92012 92013 92014 etc.

Just found out something else which I'll put on the No payment from Eye Med thread.

[pbrownlee]

The $42 copay is a discount plan that EyeMed offers some companies. They are getting to the optometrist.

[Uncle Fester]

Before submitting if the statent does not show charge bbacks- look out you are getting paid only what it says which if you followed the plan in a test case we just ran for a definity poly silh drilled avance transition is about $350 less than what it should be.

More in the am gotta catch fed ex.