Respected Contributor
Posts: 4,627
Registered: ‎03-10-2010

Re: ER Co-Pay for After Hours?

@lmt wrote:

Yes, the charge is legit. Yes, I don't like the rule. Yes, the charge is not an error.

The CS rep is the one who gave me the idea to file an appeal. I never even would've thought about doing that. She told me what I needed to do and even told me what page in the brochure to refer to. She said it can't hurt to try. So why shouldn't I?

I wrote a very succinct letter stating how unfair I thought this co-pay is. I don't feel it's fair to penalize anyone for receiving care "after hours". Do I think I'll actually get a refund? Not in a million years.

Maybe if more people weren't complacent and actually voiced their disapproval things might change.


@lmt, thanks for additional info. Since the CS rep suggested you appeal, I agree it was ok to do so. I hope you're healing well. Best wishes to you.

Honored Contributor
Posts: 15,258
Registered: ‎10-25-2010

Re: ER Co-Pay for After Hours?

[ Edited ]

@lmt @Customer Service Reps will always tell you that you can appeal.  That is the law, but if the charge is excluded from your contract, it can't be paid...period.


If want things to change...and I don't blame you, contact your HR office.  They are the ones that control the benefits, not the insurance company.


i don't think it is a copay.  A copay is an amount you would always owe upfront.  For example, some people have a $35 copay for each doctor visit.


There is also coinsurance.  Coinsurance is the percentage you wouldn't pay for services. Example, insurance would pay 80%, you would owe 20% coinsurance.


It doesn't sound like your insurance allowed anything for this charge because The shift differential  is excluded from your coverage. Most insurance plans that I have worked with do not cover this charge.


My own personal plan excludes this type of charge, but if the provider is in network, he/she cannot bill me for this charge.  Your benefits might be different.


I would still contact the doctor and ask him to not bill you.  I do know from experience that many doctors will if asked.



Trusted Contributor
Posts: 1,558
Registered: ‎03-10-2010

Re: ER Co-Pay for After Hours?

I was sitting in an ER room, waiting for treatment, when a hospital rep came in and asked me to pay the $150 ER co-pay at that very minute.  No bill after service.  Pay up!!!  Now!!! So I paid.  About six weeks afterward, the hospital refunded the payment to me.  No reason why.  Just gave it back.

Honored Contributor
Posts: 33,581
Registered: ‎03-10-2010

Re: ER Co-Pay for After Hours?

@lmt, you may not like it but it's in your coverage book and guidelines and there probably isn't a thing you can do to change that.


It is up to all of us to know what we are being charged for and what is and is not covered.


I started a reminder thread a few weeks ago when I found out that a screening colonosocopy isn't covered under my insurance.  Do I think that's fair?  Absolutely not. I think it's ridiculous. But that's the policy I am covered under and so the cost is going to be on me.  No point in appealing it for me.  It's in black and white in my coverage book.


I have a feeling things are only going to get worse.