What Is a Per Diem fee Retaining to automobile insurance?

Am I required to pay the difference between what the doctor's office fee is and what the insurance paid?

• I pay for my stepson's medical insurance. My husband's ex and I - my husband and his ex-wife do not get insurance through their work - then split the bills 73 (me)/27(her) percent of what the insurance doesn't cover. For the 2008 bills, I noticed the the ex is paying doctor bills before the insurance is applied. For example, one bill was originally $114. But when my insurance is applied, the doctor’s office and my insurance agree on a lower number than what the ex originally paid, since they are in-network providers. For the $114 bill, the doctor’s office agreed to accept $68.01 as the full payment amount from the insurance. The ex then gets a check from the insurance company, which only adds up to the lower amount the doctor and the insurance agreed upon ($68.01), not the full bill that she paid ($114). Almost all of the bills that are fully covered by the insurance have the ex paying more to the doctor’s office than the amount the doctor’s office agreed to take from the insurance. Am I responsible for 73 percent of cost difference between what the ex paid the doctor and what the doctor agreed to take from the insurance in my percentage amounts? Is the doctor’s office required to give the ex a credit since they agreed to a lower amount as payment from the insurance company? Or am I not responsible for the difference because she chose to pay up front? I know this looks complicated. Thanks for your help.

• Answer:

  If there is insurance involved, there should be no money paid up front other than your office visit copayment. The provider should bill the insurance company for the service(s) provided then send out a revised bill showing how much of the bill was paid and what the balance is. If you are paying up front, the doctor's office should refund money that was paid over what the co-insurance amount is. I know this it totally confusing,... Here is an example... Your insurance is with XYZ Insurance and you have a PPO plan that has a $250 Deductible and XYZ pays 80% of the bill (leaving you with 20%) if you use an XYZ contracted provider. There is also a $25 office visit copay that is not subject to the deductible. Type of service: Office visit for a sore throat - Treatment: the provider does a throat culture (or whatever) Costs: Up front: $25 - you do not pay for any lab fees at this time. The provider submits a bill to XYZ in the amount of $100 for the lab costs. Insurance pays: XYZ states that for this service, only $50 of the lab fees are allowed so they pay 80% of $50. You pay: Because you used a contracted provider you pay 20% of the $50 ($10) AND the provider CANNOT bill you the difference between the billed amount and the allowed amount. If this is what is happening, you should call the insurance agent or broker who is responsible for the administration or sale of the plan. They are there for a reason and have the resources available to help you with any claim resolution. I know this was long, but I hope I've answered your question.