Specialist Visit Copay Question
I went to see an Tier 1 ophthalmologist after a minor sports injury to my eye. The doc did a routine eye exam, noted a minor corneal abrasion, and prescribed antibiotic drops. My insurance states that Tier 1 specialist visits are subject to a $50 copay/visit and that the deductible ($200) does not apply.
When I received the bill, it totaled to about $190. The claim had it listed as a “Medical Visit” and showed that it was being applied to my deductible (prior to that visit, my deductible was completely unmet). I called BCBSIL and the rep attempted to explain that b/c I received care (again I just had my eyes dilated and examined) and had a diagnosis, that it wasn’t a copay visit. She essentially said that if I went to a specialist and I didn’t have any medical problems, only that would qualify as a copay visit.
Does that sound right?
To dive into the weeds, my Healthcare Booklet says:
“When you receive Covered Services in a [Tier 1] specialist’s office, benefits for office visits are subject to a Copayment of $50 per visit. A specialist is a Professional Provider who is not a Behavioral Health Practitioner or a Physician in general practice, family practice, internal medicine, psychiatry, obstetrics, gynecology or pediatrics. Benefits for office visits will then be provided at 100% of the Maximum Allowance. Plan deductible will not apply.”
It just doesn’t add up to me. Any insight would be appreciated.
