Can your medical provider collect the balance of what the health insurance denied even after you have paid your copay ?

13 Answers

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  • Flower
    Lv 7
    1 month ago

    Of course. If your insurance wont cover your claim, you have to pay.

  • 1 month ago

    Absolutely...this is how your doctor gets paid. The reasons why this happened can be addressed separately and whether or not it was justified...but ultimately, you are on the hook.

  • 1 month ago

    The answer is, in some situations, yes they can.

    The provider, if they agree to accept the insurance, agrees to accept the maximum amount the insurance will pay for that procedure or treatment. That is why some doctors will not accept Medicare or Medicaid patients, because Medicare/Medicaid do not pay enough, and why some doctors will not work with some insurance plans. That is why you should ALWAYS check with your insurance in advance to see if they will cover you with that doctor or clinic or hospital. Sometimes, you may be 'out of network', and that can leave you on the hook for the difference between what insurance will cover and what the charges are.

  • 1 month ago

    If they are "in network", no.

    If they are "out of network", yes.

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  • Judy
    Lv 7
    1 month ago

    generally yes, unless they have an agreement with your insurance to accept payment in full.

  • Eva
    Lv 4
    1 month ago

    Not if the provider is a member of their network, unless it's for a service your insurance doesn't cover at all. Wait until you get your explanation of benefits to see what happened and why it was denied. I just had one denied because the doctor's office sent the paperwork in too late. I don't have to pay for their mistake.

  • Shay
    Lv 7
    1 month ago

    A copay covers a basic visit.

    In some cases, something extra might have been done during that visit that adds an extra fee.

    YES - you are responsible for what the insurance didn't cover and was not included as a service provided by your copay.

  • 1 month ago

    Who is it due to?

  • DEBS
    Lv 7
    1 month ago

    Yes. You likely agreed to that when you signed papers at the doctors. You are responsible for their full fees. Whatever insurance doesn't cover, you owe.

  • .
    Lv 7
    1 month ago

    If your doctor is a contracted provider in your (insurance) network, then no. They can't bill more than the maximum allowable amount. It gets tricky, though, when something like radiology is outsourced.

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