Does Your Doc Owe You Money? I’d Bet My Co-Pay On It…

How many of you actually know what your explanation of benefits are? Sounds boring, I know. Until recently, I never really knew myself, primarily because I didn’t bother to pay attention to them. If something came in the mail that said I was not responsible for any payments and/or it was covered by my benefits, that was all I needed to know.

Now that I am paying my own health insurance out-of-pocket (with some government aid thanks to Obama’s American Recovery and Reinvestment Act of 2009, which reduces the cost of COBRA for the unemployed), I look at everything related to my health bills a little more closely, including my EOBs.

It has come to my attention in recent months, that I sometimes pay a co-pay at a doctor’s office when I actually don’t need to. I’m usually only shelling out about $10 to $20 a visit, depending on the type of doctor I am seeing and I’m ok with that, because when I receive my EOB, it tells me if I actually needed to pay a co-pay or any other charges. The EOB is a complete breakdown of what my doctor charges for the visit, what my insurance company pays the doctor, what I am responsible for, and what costs were not covered, if any. It is, as it states, an explanation of your benefits.

As these annoying pieces of paper kept arriving in my mailbox, I started realizing that I was paying doctors when I didn’t need to. Since there were lots of lines and numbers and insurance jargon I didn’t quite understand, I called my carrier to make sure I was understanding this correctly.

What I heard on the other end shocked me. My doctor(s) receives these same EOBs. They see that I am indeed, not responsible for these co-pays and by law, are supposed to refund me my co-pay upon receipt of this document. Let me just tell you, checks are not miraculously showing up in my mail. Are they showing up in yours?

So I have to call my doctor(s) and explain which isn’t a big deal; well, most of the time. Sometimes they want a copy of the EOB (which I can easily obtain through my online account), sometimes they already have it on file. However, there are times when I get the run around for a measly $10. One doctor made me wait four months for a refund. I was told my doctor was too busy with patients to approve this. My insurance company finally called and just like that, the check was in the mail the next day. I’ve already been refunded nearly $100 in the last 2 months in overpaid co-pays! As I mentioned, it is against the law for physicians to not refund you your money (if you are owed money) when they receive this document, because they are receiving an overpayment; they have already been paid by your carrier. That is what you pay for by having benefits (whether you are like me and pay for them out-of-pocket or you are on a company plan).

I urge you to take a few minutes out of your hectic day to go over your explanation of benefits. While it may seem like only a few dollars, it all adds up in the end. If 4,000 people aren’t refunded their $10 co-pay, that’s $40,000 lost to working Americans. And we all could use an extra few buck in our pockets, couldn’t we?


20 responses to “Does Your Doc Owe You Money? I’d Bet My Co-Pay On It…

  1. Great advice. If you can, I would leave that Doctor that took so long to reimburse you!

  2. This piece has excellent information that everyone should be aware of. Great job!

  3. Forgive me for “advertising,” but if anyone in NJ is looking for a good no-frills health plan while not working, Oxford (UHC) offers a great one for $125 and no co-pay. The best health insurance is one you don’t have to use 🙂

  4. I just found this out on my own! I Googled the topic to find out if I’m the only guy that doesn’t know … apparently not. It seems to me that healthcare reform could be done with simple things like regulating doctors against keeping overpayments. My mom worked for a physicians’ practice for years and she said this is one of the biggest rackets of our time. Wow … and I had no idea.

  5. I’ll be checking my EOBs as soon as I get home…………..thanks

  6. I just found out that I overpaid for seven doctor visits this year alone for my kids’ well child exams. Everytime I would go to the doctor they would tell me I have a $10 copay, which I never questioned. when I looked at my benefits information more closely, I realized that all physical exams/immunizations are covered 100% with no copay. So all along I have been paying the $10 copays. I will definitely be calling the doctor’s office tomorrow to see how I can get refunded my money!!

  7. Does anyone know the LEGAL amount of time that a doctor has to refund the patients money in the state of California?

    i have doctors that owe me and I am sure they are required by law to do so in a certain amount of time or I can file complaint. (At least this is the case in Texas) so how do I know the time frame in which they LEGALLY have to refund me my money?


    • Hi Amy – not sure about the California laws, but call your insurance company. They will call the doctors who owe you a refund for you and likely know the law. My insurance company was very helpful when this was the case – they even called the office while I was on the line. Good luck!

  8. So helpful Michelle – thank you!! I promise to spread the word! And this link! 🙂

  9. Hi, I have been trying to find anyone in my situation here in Florida. My doctor’s office charged me $25 and then submitted $50 to my insurance company. They also submitted three other charges, 2 were denied and 1 was approved. I paid everything up front except $222 which part of it was in dispute at the time the Flex medical insurance kicked in. I have no idea what two of the charges were for but my insurance paid on one of them causing an overage. Yes, my insurance paid the $50 office visit which I paid $25. The doctor office is saying that I had a co-pay and that they do not have to give me money back for the co-pay even though my insurance paid them. They are holding my money hostage unless I sign a statement that absolves them of the other refuted charges as well. (Yes I am refuting the charges) Does anyone know where I can get information on Florida law? I found your article and Thanks for that

  10. Contact the Florida Insurance Commission which you can find online. Good Luck. (Ms. Florida)

  11. I’m very happy to find this site. I’ve had questions about Medical bills I receive. Some are from places I’ve never been to.
    But about overcharges. I paid off a bill from one Dr, then the next month received a bill for half of what I paid on the final payment.
    I figured it out that I had being over charged. So I personally took the bills to Dr’s office, ask for someone in the Billing Dept, handed them my bills for the last 3 months and ask “what’s going on here?”. The girl looked at the bills then ran into the Dr’s office. She came back and said. “it looks like you’ve been over charged, We’ll cut you a check and send it to you.
    Haven’t heard a word.
    BTW, This payment was for an screening appointment that was cancelled
    over the phone and before the appointment was offially set, Medicare was charged also, So I’ve been wondering if fraud was involved.
    Most of the Medical bills aren’t itemized but blank with the amount I owe.

    There are several other questions I have about legality in the medical field.
    Including Medicare fraud.

  12. I know this thread is older but I just found it. Out of curiousity does anybody have a flexible spending account? My husband has one that we use through his work and it requires that anytime it’s used for doctor visits we have to send a copy of the explanation of benefits. Problem is the EOB’s never match what we have payed at the time of service. Is there any way around this? Or do I just have to check every EOB after the appointment and hit them up for a refund right away to send to the company to account for all the money that was spent? it’s rather frustrating. Just this year alone I’ve paid $619.70 on our FSA and only have EOB’s that account for $493.01. which means they are going to have their hand out for the remaining $126.69. Which by the way was our money to start with. They tell us we can only use it on certain things and that we have to pay them money that gets put back on our FSA balance or they suspend our card? Weird if you ask me. Used to be able to buy over the counter medicine from the store and now you can’t do that anymore either. Any help is appreciated on how to keep things in order and keep all the money accounted for. Thanks!

  13. Im having a teeny problem. I cant get my reader to pickup your rss feed, Im using msn reader by the way.

  14. Good luck getting a refund. I have told one of my doctors I DONT have a co-pay anymore, but they still collected it. Even after I faxed them my EOB I cant collect. I am not sure how long they have to issue a refund but 3 months is to long.

    • Do not let this provider put you off. I work in a medical office and this happens all the time. I put in for refunds to go back to the patients all the time and the owners do not send them back. You do not have to produce a copy of your eob they will have one on file. Always bring up that you are calling your insurance co to tell them that the provider is billing Fraudulently. Also let them know that if you have to get a lawyer involved they will paying for the court cost.

  15. This many be an old story, but I just realized that several different medical practices are charging my family and I for co-pays that we were not responsible for. I think this practice is far to common and something needs to be down about this. This is fraud… instead of stealing from Medicare they are stealing from their patients!

  16. I have had a similar issue I am trying to get resolved. I had OP surgery & was told I needed to pay to meet my deductible – so I paid the surgeon $800 from my flexible spending acct. Come to find out after the fact my EOB said I only owed $200 – so I overpaid by $600! I have called the dr’s office & have been assure they will refund me what I am owed but it’s been 2 1/2 weeks & still no payment.

  17. I thought auto mechanics and appliance repair people were bad. Doctors act like they have a license to practice medicine and one to steel. They wonder why we hate them or at least I do.

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