What does "These services are subject to the Co payment only" mean?

Question

I just got insurance coverage through my work. When reviewing the information that came in the mail, I keep running in to the same terms and I can't find laymen definitions for them.

Basically, I have a $1,500 deductible, so I know that that needs to be paid before the insurance company will pay anything. But when I was reviewing the costs booklet I got confused again.

To visit an In-Network family physician it says $35 copayment per visit*. the * at the bottom says "These services are subject to the co-payment only" now does this mean I will only pay the $35? In the benefits booklet it says "Covered services, which are subject to a copayment are not subject to the calendar year deductible"

So if I have a co-pay when I go to the doctor, I won't have to pay the entire bill, even though my deductible hasn't been met?

Answer 1

You have the correct interpretation.

The services that say "copay only" mean that your deductible won't have to be met for the insurer to pay those particular services.  You'll just be obligated for your copay.

One word of warning - when it says that the doctor's office visit is "copay only," that means the charge for the office visit itself.  Other stuff the doctor does in office (labs, xrays, in-office procedures, etc) will still have the deductible apply.  Some people don't realize that until after the fact, and get upset when they get the bill.

Answer 2

~~Yes you will only pay a copay for doctors visits. Your deductible starts applying when for hospitalizations, test and blood work, medications, and procedures are the norm.~~