Billed two ER copays for a single ER visit. I am so frusrated.

I don't know if I am just missing something obvious here, or what.

My family is enrolled in an employer-funded EPO administered by Centivo. We live in WI but the hospital in question was in Colorado. We were on a camping trip and our kid ended up in the ER in the middle of the night due due to mesenteric adenitis. My husband and daughter got to the emergency room around 11:15-11:30pm. They checked in and were put in a room by midnight. She was examined, treated with pain meds, given a script for more meds, and they left around 2:30. She was not admitted and neither of them left the ER (or the room for that matter) the entire time.

We have a $250 copay per ER visit. We are supposed to have access to the entire plan document through our Centivo member portal – there is a link where it is supposed to be – but the link is dead. (This is an entire other issue – I have messaged Centivo multiple times asking for this and nothing….we are trying to ger this from HR now.) Anyways, I don't have the entire plan document, but I do have a 10-page summary with all the copays/deductibles/etc. outlined – we clearly pay "$250 copay per visit" for the ER, not $250 per calendar day.

I called the hospital, and they said that they sent their billing to Centivo, and the info they rec'd back simply stated we owed a $500 "total copay." I called Centivo, and the rep I spoke with confirmed that Centivo told the hospital we should pay $500 in copays for two visits, because we were in the ER for a three-hour period spanning two calendar days. They confirmed it's exactly the same copay – it's not a matter of a visit copay plus a different facility charge or specialist fee. I asked for the claim to be formally reviewed, and got an email less than 24 hours later that Centivo decided we still had to pay 2 identical copays for the same visit.

I feel like I'm taking crazy pills here. Am I missing something?

submitted by /u/poopshoes53
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