Please explain how a health insurance deductible works?

Question

if i get health insurance, and the deductible is 1000 dollars, and the copay is 30 dollars,

then i need to go to the doctor,

do I pay the 30 dollar copay? or do I have to pay for the whole visit since I haven't spent 1000 dollars yet?

Answer 1

the 30.00 copayment is what you would pay.  if you have surgery, x-rays, CT scans, MRI's - you may need to then pay your deductible first.  hope this helps.

Answer 2

you pay 30 per visit. Co-pays usually only come into play when you are having some procedure done. Then you would be liable for the 1000 dollar co-pay and usually a smaller percentage, i.e. 20%, of the rest of the bill.

Answer 3

Actually...it depends. With some policies, you will pay a $30 copay and that's all. With others, you may have to meet the deductible before the copay option begins.

In fairness, there is no blanket correct answer. So much depends on your particular policy and the policy provisions.

Answer 4

The deductible is what you have to pay out of pocket before your insurance will pick up the rest

Answer 5

You will pay your copay of $30- then after your insurance processes the claim, you will get a bill for the allowable amounts of the visit which was charged.  You will be paying about 75-80% of the whole visit on average.  Once you have met your yearly deductible then you will pay only your copay of $30.

Answer 6

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Answer 7

Find out what the deductible is for. Usually it's only for hospital emergencies. The copay usually refers to a scheduled dr. visit.

Answer 8

The 1000 dollar deductible is for hospitalization, and outpatient surgery.  For a doctor visit, you just pay 30 there's usually a totally different deductible for emergency room visits, its usually lower than your hospitalization deductible

Answer 9

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Answer 10

Shannon,

I like to begin answering a question by equating it to something you already understand...from there it's easy.

As an Insurance agent I get this question asked A LOT!

Let's just talk about the Deductible first...If you have automobile insurance then most likely you have a deductible. It's generally $500 to $1,000 and most people don't even know it because they never get into an accident...but it's there. Therefore, if you never side swipe that telephone pole coming out of the grocery store you'll never have to pay your deductible.

Health Insurance works in a similar fashion...but not exactly. On the plan you mentioned, most likely the standard Dr. visit is a $30 copay, but if lab, x-ray, tests..anything is done that does not have to do with the standard visit then this amount is charged at the carriers "negotiated" rate and you pay it. That amount REDUCES you deductible by the same. For example, if your lab tests were $200 (negogiated rate) then your deductible would go down to $800. By the same token, if you needed and emergency appendechtemy, you would immediately meet your full $1,000 deductible and it would be satisfied.

Health Insurance deductibles work on a calendar year basis - Jan 1 to Dec 31...So, if by chance something was to happen on Jan 1 then your deductible is satisfied for the remainder of the year...which works out well. But, something could also happen on Dec 30th...so, you take the good with the bad.

Hope that helps...take care,

Blake

www.healthanddentalplans.net

Answer 11

You pay the office visit co-pay for the doctor's visit.

Generally, any service that is not identified as having a co-pay, will be a service that is applied to your deductible.

Answer 12

You have to pay for the entire cost of the visit until your deductible is paid. Probably a bill in the mail. Plus you would have to pay 30 dollars for your copay unless it says 30 dollar copay after deductible.

Answer 13

Your policy has a $30 co-pay for doctor visits, and probably around $15 or $20 for co-pay for (generic) prescriptions . So when you go to the doctor and (s)he says go home, take two aspirin and call me in the morning - it costs you $30. However, any additional services performed in your doctors office, such as x-rays or lab tests are usually, but not always, subject to the deductible, so you may have to pay for them, up to the $1,000 annual maximum. Treatments or services received at a hospital are also subject to the deductible  The $30 that you spent for the doctor visit does not apply towards the deductible.

Don

http://mtnhealthinsurance.com

Answer 14

you pay the 30 dollar copay.... you will get a bill and you will pay as well until u meet ur deductible after that only copay

Answer 15

You'll pay your co-payment each time you visit the doctor for an appointment. If you get admitted to the hospital, that's when the insurance kicks in most fees AFTER you pay the deductible.

Answer 16

You will have to read your policy thoroughly.

You can also go to your state department of insurance. There is a glossary there and you can seek info from the state attorney general.

That is your safest turn.

Answer 17

no look the health insurance ok well i dont know

Answer 18

It depends on your plan. You should call the member services number on the back of your card to ask exactly where the deductible comes in to play. The deductible may only come into the scene for out-of-network providers or outpatient procedures (like lab tests or X-rays) or it may be for hospitalizations.

By calling member services before you need to see a doctor you'll hopefully avoid an ugly surprise in the form of a bill. =)

Oh, and to answer your original question - if you have to meet the deductible first - have the provider bill the insurance FIRST, then bill you after. This is the only way (aside from you sending in the bills yourself, which is a hassle) that the insurance knows when you meet your deductible. Also, you'll pay less than a non-insured patient would pay because you'd be paying what the insurance would pay the provider, which is quite often significantly less than the cash price.

Answer 19

You can't go to the dept of insurance to find out.  But, you can look at the brochure.

Usually you pay the $30 for office visits and surgeries, labs, xrays, hospitalization, etc... is paid in full by you until you've reached the deductible.

HOWEVER, some policies are different.  Sometime you'll pay the full cost of the visti as well until the deductible is met.  AND, sometimes lab & xray is covered by the copay.

So, if we had to answer the most likely choice would be that you pay the $30, however the whole visit would still be a possiblity.  YET still, even if you pay the 'whole' visit the insurance company is likely going to knock that 'whole' cost down.

Also, the $30 copay doesn't count towards your deductible....again 'usually...'