Office Visit Copay or Not???

Having trouble choosing a plan of coverage?
Do the plans that you can afford not have office visit copays?
Are they limited?

No matter which plan you choose the #1 benefit every member of each carrier receives is that they have access to the provider network.  When you seek service at a "in-network" provider you are subject to the negotiated rate of service, not retail..prior to the plan deductible being met.

The negotiated rate is applied to all covered expenditures.

All plans will cover preventative care services at 100% with no cost obligation to the insured.

So..back to having an office visit copay.

So, if your plan has a copay, then this is a fixed amount, on the negotiated rate, that you will pay for the cost of consultation when visiting a specialist or non-specialist.  The copay amount paid does not apply towards the plan .  Some carriers have 2 separate copay amounts, one for a specialist and one non (lower).

Clicking this office visit claim for a recent specialist visit of mine, will show the final cost I owe the provider after my insurance carrier, BCBSIL, processed the claim.  The retail cost was $170 in which I was only allowed to be billed $71.

If my plan had a copy I would have owed at time of service.  By not having a copay, I am billed this amount by the provider, and when paid, it goes against my deductible reducing my overall risk.

Keep in mind that this visit was for a specialist and I was an established patient.  If I had been a new patient, the retail cost would be close to $300.

Now, when choosing a plan you may notice that the copay amount is the difference in price between a plan without.  So..if you have do not visit the doctor frequently, the premium savings will be enough to cover the cost of your office visit consultation.

For any questions please contact the shoppe.

Thanks,

Jordan