I had an appointment today with an ENT. My insurance says I have a $60 copay for specialist dr visits, so that’s what I brought to the appointment. The receptionist told me “so you have a $750 deductible on your contract, how much can you pay today?” My insurance card does mention a $750 deductible. I asked “well how much do I need to pay” and she said something like $30. So I asked if that was in addition to my $60 copay. Then she said, no that’s a percentage of the deductible (no idea what she means by that.” But then she said “if your insurance says copay is $60 then pay $60” and she said an office visit is actually $200 and insurance won’t pay until I’ve met my deductible, but that the doctor and I will get a discount through my insurance and my $60 copay will count towards the $200. Basically I’m very confused about deductible vs copay and how they relate to each other.
In: Economics
I’m oversimplifying but this is ELI5…
Copay is how much you have to pay each time you have an appointment. Your insurance doesn’t cover copay.
Deductible is the maximum amount you have to pay each year for medical stuff. Once you’ve spent more than the deductible, your insurance pays instead.
Example: Your copay is $50. Your deductible is $500. In one year you have two doctor appointments and tests that cost $800. That means that in addition to whatever you are paying for insurance, in that year you will pay $100 in copays and $300 for tests.
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