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
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