eli5 how US health insurance deductibles and copays work

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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

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Anonymous 0 Comments

I’ve got a $3000 deductible and a $7000 out of pocket through my work. I broke my ankle and had to have immediate surgery on the 15th of January and somehow, despite me not paying any of that yet, I have met both my deductible and out of pocket. Not sure how any of this works, but it’s made insulin and everything else much much cheaper. I feel like this shit is set up to be intentionally difficult to understand

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