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Incorrect Member Cost Share Application - Provider Overpayment

Date: 08/05/20

In mid-July our Medicare Benefits Team discovered an error in the setup of our $15 specialist copay. Between 1/1/20-7/14/20 our benefit was erroneously set up to only apply the $15 specialist copay one-time per year, per provider. As a result, the system may have only applied the $15 co-pay to the first specialist visit from 1/1/20-7/14/20. If the member had a follow-up visit, the co-pay was not applied when we processed the follow up visit for payment.

Effective 7/14/20 our Medicare Benefits Team corrected the set up to apply the $15 specialist co-pay once per day, per visit, per provider. Dates of services processed after 7/14/20 will reflect the $15 specialist co-pay amount. We did not subtract the co-pay amount from payments made to you for services provided prior to 7/14. These claims will NOT be reprocessed.

Please accept our apologies for our error and reach out to our Provider Engagement Team at if you have questions.