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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Recent Posts
What is a Summary of Benefits and Why Should I Read It?
A summary of benefits (SBC) is a 4-page document explaining a health insurance plan’s coverage, costs, and examples. It helps compare plans, understand costs like premiums and deductibles, and assess coverage for services like doctor visits or preventive care. Available through Nevada Health Link, the SBC is standardized for easy comparison but does not include provider networks or full exclusions. Learn how to use the SBC to choose a plan that fits your needs.
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What is a Prescription Drug Deductible?
In the world of health insurance, “deductible” is a common word. It refers to an amount of money that you pay out of your pocket before the insurance company begins to pay. A prescription deductible is the portion you’d pay first, then after you’ve paid the deductible, you may only have to pay a co-pay when you pick up your medication.
If you are single, you would only have to meet your prescription deductible. If you have two or more people in your family, each member may have to meet their own prescription deductible which could be up to 2 deductibles in the family. A prescription deductible is different and separate from the medical deductible, unless otherwise stated. One deductible is for medical, ie: hospitalization, doctors, etc., and the other deductible is for filling your prescriptions.