Do you know how a copay works for office visits?

Do you have an office visit copay?  If so...with new healthcare reform, this copay is only applicable for office visits other than preventative care which is covered at 100% by your insurance carrier.

A copy is only to cover the cost of consultation..any and all additional lab work or diagnostic testing falls under a deductible expense.

So, for primary care when you are an established patient, the true cost after insurance can be anywhere from $40-$60 to what you will be billed by the provider.  If you have a copay then this will pick up that cost and is owed at time of service.

By not having a copay you will be billed the allowed amount (negotiated/contracted rate) to which is applied towards the plan deductible, chipping away at your total exposure.

Choosing a plan without a copay can save an insured anywhere from $30-$40/month.  Therefore, when you are billed the premium savings will make up the difference by not having a copay and you receive the benefit of having the expense go against the deductible, where copays do not.

Now, the only time a copay might be beneficial is when the insured is a "new patient" for a specialist or non-specialist.  When an insured is a new patient they will be billed a higher amount than normal.  This can be anywhere from $150 for primary to $300 for a specialist.  Once insurance is presented the cost will drop anywhere from 30-70%.

Once the insured is an "established patient" the cost will be dropped as noted above.  For specialists, an insured can expect to pay anywhere from $50-$80 after insurance.

Most plans now have copays of $20-$35 for primary with $35-$60 for specialists.

For more information please call the shoppe.

-Jordan

New Preventative Care Benefits

For those who have had a health insurance policy issued later than 3/23/2010, effective 1/1/2011 your preventative care benefits are covered at 100% by your insurance company with no annual maximums.

Please click the below link for a list of services that the department of Health and Humana Services (HHS) deem covered.
http://bit.ly/9twrh5

Now, as of late...clients of the shoppe have been receiving bills from their insurance company for their recent routine annual checkup.  Depending on doctors, these visits can cost $150-$260 after insurance.  This is the amount that your Explanation of Benefits (EOB) states you may owe the provider.

When reviewing these EOB's, physicians are coding their claims as medical visits with all lab work being billed as diagnostic.  This leads to the insured receiving a bill for covered expenses.

If this is happens, you must call your provider and ask for them to resubmit claims under the right coding and must include medical records for that day of service.

If you have not had your annual checkup...make sure to notify the providers office to code claims as preventative or routine.

Please feel free to contact the shoppe with any questions on this.

Thanks,

Jordan