by chibuzo.ugenyi » Wed Oct 03, 2012 08:31 am
In the plan that I'm looking at, it says "$30 copay for 3 visits, then plan pays 70% after deductible". Does that mean that I will have to pay the full doctor's office price for visit 4+ until I have paid all of my deductible -- then after I have paid all of my deductible of say $3000, then the insurance company will pay 70% of doctor visit costs?
Posted: Wed Oct 03, 2012 11:13 am Post Subject:
This is an unusual description of a health insurance benefit. But if accurately stated, it would mean what you have asked. Three visits at $30 each, plus 100% of the cost of future visits until the deductible was satisfied, then the insurance company would pay 70% of future expenses for the rest of the year.
If you can scan and email your contract or summary of benefits / outline of coverage to me, I may be able to give you a better answer.
Posted: Sun Nov 04, 2012 05:11 pm Post Subject:
Yes, but you only pay the network negotiated rate or allowed amount for in-network charges. The network negotiated rate or allowed amount is how much the Doctor will accept as full payment due to being an in-network provider of the carriers network. This works out in your favor as the charges they accept are less than retail. You should also be getting 1 well visit per year under a $0 copay in addition to those 3 sick visits.
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Robert Colucci
Website: https://rtcinsuranceadvisors.com/
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