This has happened often enough that it can't be a fluke. A regular doctor visit is supposed to have a $25 co-pay. I made a regular doctor visit last December. A bill just showed up in the mail. The insurance didn't cover $10 of the doctor's fee. The doctor now wants another $10.

What will happen, what always happens, is that I'll call the insurance and yell at them and they'll pay the $10. They make this sufficiently painful that it's almost easier to just pay the $10. This makes me suspect it's a deliberate business strategy. My employer negotiated for a certain set of rates and co-pays and heaven knows what else, and this is how the insurance company tries to make extra cash. Very annoying and probably makes them liable to a class action lawsuit, if only somebody were sufficiently annoyed as to bother suing them.

Things like this make me glad we have a National Health Service in the UK

This happened to me before. Turned out that my GP had somehow been registered with the insurance company as a specialist, which required a higher copay. No idea if that's the case with you or not -- certainly my doctor's office knew about it, as every patient with the same insurance company as me was having the same problem. Eventually it got fixed, and the doctor's office floated the extra money until it was.

I guess my point is, ask your doctor's office about it if you haven't already.

The "specialist" angle is almost certainly what happened, but it's still entirely uncool. I went in with yee-olde annoying cold to see if I needed antibiotics. I certainly wasn't in need of specialized treatment (and, in fact, wasn't even in need of antibiotics).

I guess the point that I left out is that the doctor needed to be reclassified as a GP instead of a specialist. (ISTR him being classified as "internal medicine", which the insurance company classified as a specialty.) If your doctor is, in fact, a primary care physician, then he should be classified as a generalist with the insurance company.

I just got off the phone with the insurance. Turns out, a doctor only counts as your primary doctor if you declare them as such to the insurance company. I've now made the appropriate declarations. Lovely. Even more complicated is dealing with my sabbatical in California. Apparently, I can change the "service region" for my wife and daughter by just saying so, and they can then go "in network" anywhere that's part of the insurance company's "HMO" plan. I, however, don't have that luxury. To change my service region, I have to ask my employer to do it for me.

Does any of this strike any of you as unnecessarily complicated?

If it wasn't, how could they screw you? Come on. Wake up to the American Dream!

Also, never go with the HMO option if you have any interest in reducing complexity.

Hehe, but what an important two.