A Rare and Unexpected Refund

Well, the very afternoon I finished the video on Provider Overpayments and my unsuccessful attempt to obtain one from my ophthalmologist, I received an unrequested $6 refund check from a retinal group.

At the time of visit, I was asked to make a $41 copayment. The office has every right to request the copayment at the time of service. Of course, that my plan, CIGNA, has both a $41 copayment (an odd amount) AND a $35 copayment for specialist visits seems rather silly since both the practice and the patient don’t seem to have enough information to know which is the proper amount. Later, I could see on my CIGNA portal that the claim was processed showing that a $35 copayment was owed. Similarly, when I had my annual skin check, I paid a $35 copayment but the claim was processed indicating I should have paid a $41 copayment.

When both the patient and the provider office have so little insight into what the appropriate copayment is, that is a benefit design flaw. But today we won’t go there. Today let’s recognize that New England Retinal Associates is run with integrity and honesty. I wouldn’t have bothered to request a $6 refund because I have too much respect for the value of administrative time. Anyway, it is refreshing to see people who appreciate balanced books and manage the practice with that objective in mind. In a world of extraordinary healthcare complexity, however, we should be constantly striving for a “keep it simpler” mentality. Be on the lookout for practices you admire and practices you don’t and share them with us.

And, please, watch the video. Thanks.