Whenever you visit a doctor's office the nurse behind the desk is going to ask for your medical card and ask if your plan provides copayments for doctor visits. If the plan provides that you will pay a small fee for service rather than the entire fee. Copay plans cost more than straight deductible plans, but when you pay a nominal fee when you visit a physicians office you may feel pretty good about your decison to purchase a plan with copayments.
A copayment, or "copay" as it is sometimes called, is a flat fee that the patient pays at the time of service. After the patient pays the fee, the plan usually pays 100 percent of the balance on eligible services.
Eligible services are those services that the plan includes in its coverage. The fee is usually small, such as $20 to $50. Copayments are common in PPO products, and in HMO's.
Sometimes you must pay a higher "co-pay" if you have not received approval from your primary care physician to see a particular specialist or go to the emergency room. It is best to find out what kind of co-pay you have for mental health visits. Payment is usually expected at the time of the service.
What copayments cover varies between providers, even the amount of office visits per year can vary as some companies offer as little as two, and others offer unlimited doctor visits.
Obviously the ones offering unlimited doctor visits, wellness, and drug copayments are the most benefit rich, and sometimes more expensive, but that is not always the case.
Some plans will cover lab fee's and wellness under the copay, other plans may just cover the doctor visit, and not the diagnostic services performed during the doctor visit. Make sure to read carefully before buying so there will be no misunderstandings about the coverage you have purchased.
In Illinois BCBSIL, and UniCare have the most competitive rates and benefits. Other competitors products actually cost more and offer fewer benefits in most cases. So examine what you are buying, make sure you are getting the most benefits for the dollar.
Copayments can also be used with prescription coverage. Most plans will charge around $10 for a generic, and $30-$50 for a brand name drug. If you pick a plan with prescription coverage make sure that you have a solid fee, and not just a percentage to pay of the prescription amount.
Seperate copayments can also be applied toward emergency room. BCBSIL plans have no copayment or deductible to satisfy for the emergency room, while most other plans apply emergency room visits to the deductible. The new UniCare Sound plans have a $150 deductible for emergncy room visits. The main attraction for young active families to BCBSIL is the emergency room benefit.
It is important for the consumer to understand exactly what they are buying because coverage differs greatly between companies and the different plans they offer. Don't assume that the most expensive one is best, because in most case it means little.
Visit www.medequote.com to view competing plans and learn about how health insurance works, and what is the right fit for your family.
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