What You’ll Pay At The Doctor’s Office Or Before Surgery
A health insurance co-pay (copayment) is a set dollar amount you pay for a procedure or office visit (look at your plan summary very carefully). A co-pay is helpful because you’ll GENERALLY pay just the co-pay (unless other procedures are billed by your doctor in addition to the co-pay). For example, let’s say you see your family doctor for a sore throat. If your plan has a co-pay of $35 dollars, you’d pay the $35.
Sometimes you can be billed more than just a co-pay. For example, let’s say you went to a specialist (specialist co-pays are generally more than a primary care doctor) to have a spot on your skin looked at.
The office co-pay may be $75 meaning you would pay that much for the office visit. But if the doctor wanted to remove the spot, he could charge you/your insurance company for a “procedure” that is charged in addition to the co-pay. That would be two charges in one visit. So, the procedure could be billed to your insurance company, and you’d pay whatever your insurance company had negotiated with the doctor for that procedure, and that out-of-pocket cost would apply towards your deductible, and the co-pay would apply towards your “out-of-pocket maximum” (the absolute most you’d pay in any calendar year).
In most cases for surgery, most plans will not have a co-pay, but will have a deductible. So, there won’t generally be a co-pay, but before your procedure, you may be asked by the doctor’s office or surgical center or hospital to pay a certain dollar amount. This amount will come off your deductible amount. So, co-pays and deductibles are different, but anything you do pay, whether it’s a co-pay or deductible all applies in one way or the other towards your “out-of-pocket maximum”.
Getting Started With Nevada Insurance Enrollment
While this is a generalization on how most plans work, it’s important to know how your plan works specifically. Navigating through the many options of insurance can be confusing but speaking with a locally licensed insurance agent will help you to obtain the right coverage you need. You’ll have the peace of mind knowing that you are adequately insured when life complications arise. We work hard to find the most competitive quotes, and best coverage for your needs. Contact us today to begin the process of finding the best insurance plan for your family.
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If you’ve missed the open enrollment period and don’t have a qualifying life event that would allow you to enroll during a special enrollment period, you still have options.
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Recent Posts
Affordable Care Act Pros and Cons: Will It Last?
While a lot of good has come from the law, there have been serious downsides as well, leaving many to wonder whether the ACA will stand the test of time or be repealed and replaced.
What is Covered By Obamacare?
Preventive services are covered under the Affordable Care Act at no cost to the insured. This means there is no co-payment or deductible. There are specific services provided for all adults and specific benefits provided to women and children.
What Happens If You Forget To Pay Your Premium By The Due Date?
Life happens, and while you should make every effort to pay your health insurance premium on time, health insurance plans generally will have grace periods. You may have a grace period of 30 days, or if your insurance plan is through Nevada Health Link (on-exchange), it may be up to 90 days.
Where To Go: Emergency Room or Urgent Care?
There are distinct differences between hospital emergency rooms and traditional urgent care centers, including the level of care that can be provided at each location.