State Health Plan, Charge for Cast in Doctor's Office? (wedding, deductible)

[go tribe!]

Hello,
I am a new teacher in North Carolina and had a mishap just weeks before my wedding in July - I fell and broke my wrist! However, I have had nothing but trouble trying to get Blue Cross Blue Shield to pay what should be their share. I have tried to call them today, but are closed, and will contact them Monday with this problem, but I am writing to see if anyone has had this same problem.

I have paid my office copay for the visit to the Orthopedist Surgeon ($60), where I received a cast. I received an "Explanation of Benefits" from BCBS that states the visit was billed under "Surgery" and that my doctor may bill me $219.02. However, under the summary of benefits it says that doctor copay's include "office surgery, x-rays and lab tests."


Has anyone paid for a cast that was put on in the doctor's office, where a copay was already paid? According to the summary of benefits, I don't think I am responsible - but maybe I am missing something?

[NancyfromNC]

Your copay is for the office visit only. It's referred to as an E/M (evaluation and management) by the doctor. If he decides to do anything else such as xrays, casting, labs, etc..... all of that will be applied to your deductible which starts again on July 1st of every year. After you meet your deductible then BCBS will pay a percentage of the charges and the rest falls on you. Sorry about your accident.