Can an eye doctor’s office keep a co-pay if there was no visit made?

It was not a no-call, no-show situation but there was a cancellation andreschedule. I paid in January for a visit in February. Called in January to reschedule but the doctor would be out. We agreed to try again when schedules allowed. I went to the office twice more to attempt to be seen. Again the doctor was not available. Now the insurance coverage is lost due to layoff. They are giving a grace period of 6 months to allow credit of the co-pay, but if no visit made withing that time, they will not refund the co-pay. Nothing was stated prior to the transaction or on the receipt.

Asked on December 13, 2010 under General Practice, Georgia

Answers:

M.T.G., Member, New York Bar / FreeAdvice Contributing Attorney

Answered 9 years ago | Contributor

A co-payment is your portion to be paid of the medical charge for services rendered to you by a medical provider in your insurance plan.  If no medical services were provided then payment can not be collected.  It would be a form of insurance fraud.  My concern her is did they also bill the insurance company for the visit as well.  I would double check on that.  If they already did then that really is insurance fraud and you have them in a very uncomfortable place here.  Check with your insurance company as to the submission of a claim(do you get statements explaining claims submitted from your insurance company?) and then call back the office and let them know that you are going to report them to the Department of Insurance and the State attorney general's office.  And then do so.  Good luck.  


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