Strange question I should know the answer to, but I’m just not sure. Provider office looking for help with a claims scenario – TIA!

My clinic sees several patients from a large local employer group (hospital) that switched carriers this year. Based on the plan documents it looks like it is structured identically to the previous carrier plan, which bumped providers not employed within their health system down to secondary tier in which outpatient rehab is subject to deductible, versus being covered with just a $30 copay if seen by a therapist in-house. However, claims are coming back this year with just a $30 copay as patient responsibility so far. This would obviously be great for our patients, but I'm concerned it is a processing error and we may be looking at a recoupment somewhere down the line. Is that a very common occurrence? Should I call to make sure? Or should I go with it and just alert patients to the possibility claims could be reprocessed? I don't love the idea of triggering a higher cost burden for people, but if it will likely happen anyway I'd prefer to get ahead of it and make sure patients in this group don't get hamstrung with unexpected bills. Regence Group Administrators is the new carrier.

Thanks for your help!

submitted by /u/notevenglennclose
[comments]