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
A deductible is some amount that must be paid by the patient before *any* amount gets paid out by insurance. There might be more than one deductible, such as one for medication and one for procedures, and there might be an individual deductible and a family deductible.
A copay is some amount that must be paid out even after the deductible has been met. This might be a different amount for different things.
For example, imagine I need some medication that costs $100 a week. I have an average $1700 deductible. The first 17 weeks I’m paying 100%. After 17 weeks, I’ve paid my deductible, so insurance will start covering. The copay might be $12 for medication, so every time I get more meds, I’m paying $12 for the copay, and then the insurance covers the rest.
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