I have a PPO health spending account and it says deductible plus 0% coinsurance for doctor visit?

Question

My deductible is $2500...which is accurate for this type of insurance plan (its not high people). Does this mean I have to pay $2500 before I can see a freakin foot doctor? lol

Answer 1

NO, it means that you have to pay the bill.  And you want to submit it so that the cost is applied to the deductible in the event your bills get that high during the year.

In the meantime, you'll be billed at the insurer's contracted (reduced) rate with the doctor AS LONG AS you file the claim.  Otherwise you could be charged whatever the doctor wants to charge you.

Answer 2

With the plan you described you pay the first $2,500 for all your medical care, DR visits, prescriptions etc, this is the deductible.

After  you meet the deductible the insurance company pays 100% of your care for the rest of the year and you pay 0%, this is your coinsurance.

You can visit the DR and they may have you pay a small fee, but they really won't know what to charge you until the file the claim with the insurance company.

Once the claim is filed the insurance company will send you and EOB (explanation of benefits) This will show you the DR fee the insurance discount and how much you owe.

It sounds like you have a Health Savings Account (HSA). To use the account to pay your medical bills you must have the HSA opened before you  receive the care. Then you have the advantage of paying for your medical care with tax free money. The money you deposit into the HSA can be written off your taxes just like an IRA.

Answer 3

Agree with 1st answer, you need to give your health ID card at every visit and pay the out-of-pocket until you hit the deductible.

The deductible refers to the amount of money that the insured would need to pay before any benefits from the health insurance policy can be used. This is usually a yearly amount so when the policy starts again, usually after a year, the deductible would be in effect again. Some services, like doctor visits, may be available without meeting the deductible first. Usually there are separate individual deductible amounts and total family deductible amounts.

Since you have 0% co-insurance after $2500 you should be good after that. Coinsurance or copayment would be the amount that would need to be paid by the insured before the insurance pays and in addition to the deductible. Some health insurance plans will let the insured use some services with just the coinsurance payment, like visiting the doctor, even before the deductible is met.

Your policy may have "max out of pocket" listed somewhere as well, which is the cost one would pay out of their own pocket. An out of pocket expense can refer to how much the co-payment, coinsurance, or deductible is. Also, when the term annual out-of-pocket maximum is used, that is referring to how much the insured would have to pay for the whole year out of their pocket, excluding premiums.

Good luck!