So you went to the doctor, paid your co pay and now you are receiving a bill in the mail for an additional amount. Many people go through this each year. It is all about understanding your plan, claims, payments and coding when it come to health insurance.
So you paid your copay when you went to the doctor and now youre wandering why you are getting a bill from that visit. Well if the bill is for lab or x-rays, then that is because typically these procedures are not covered under the copay. Many people do not understand this.
For example, an office visit from a coding perspective includes 5 Levels of codes. The levels reflect patient status and complexity of the office visit. These 5 codes typically are what is covered under a copay. If there is any other code, such as for lab test or x-rays, you will likely encounter other charges.
If the charge does not fall under the copay then it is likely subject to deductibles and co insurance. The amount you pay is based on negotiated rates if you have seen a in network physician and deductible and co insurance status at the time of visit.
If at the time of services you have not meet your deductible then you are responsible for the total charges until you have paid that deductible amount out of pocket for the year. If you used a in network provider or facility you will be charged a negotiated rate.
If you have a co insurance, then once you meet your deductible you still have to pay some out of pocket. Let's say your co insurance is 80/20, then you will have to pay 20% of any charges incurred until your co insurance maximum is meet. If you have no coinsurance or your co insurance has been meet then your insurance company will pay 100% for the rest of the year.
You need to know if your insurance company goes by calendar year or anniversary date. This makes a huge difference and is reason for much confusion for many. If they go by calendar year then no matter your time of policy purchase everything (deductible and co insurance ) will start over on January 1st.
If you are only allowed 1 preventative exam a year, then you better be sure your year us up before the next exam or you will be paying for that exam out of pocket. Also make note if your preventative benefit has any limitations or maximum payout. If you are going to the doctor for what you call a check up because you have been having some sort of symptom, this is not a preventative or well visit, so make sure your doctor does not code it that way.
So you paid your copay when you went to the doctor and now youre wandering why you are getting a bill from that visit. Well if the bill is for lab or x-rays, then that is because typically these procedures are not covered under the copay. Many people do not understand this.
For example, an office visit from a coding perspective includes 5 Levels of codes. The levels reflect patient status and complexity of the office visit. These 5 codes typically are what is covered under a copay. If there is any other code, such as for lab test or x-rays, you will likely encounter other charges.
If the charge does not fall under the copay then it is likely subject to deductibles and co insurance. The amount you pay is based on negotiated rates if you have seen a in network physician and deductible and co insurance status at the time of visit.
If at the time of services you have not meet your deductible then you are responsible for the total charges until you have paid that deductible amount out of pocket for the year. If you used a in network provider or facility you will be charged a negotiated rate.
If you have a co insurance, then once you meet your deductible you still have to pay some out of pocket. Let's say your co insurance is 80/20, then you will have to pay 20% of any charges incurred until your co insurance maximum is meet. If you have no coinsurance or your co insurance has been meet then your insurance company will pay 100% for the rest of the year.
You need to know if your insurance company goes by calendar year or anniversary date. This makes a huge difference and is reason for much confusion for many. If they go by calendar year then no matter your time of policy purchase everything (deductible and co insurance ) will start over on January 1st.
If you are only allowed 1 preventative exam a year, then you better be sure your year us up before the next exam or you will be paying for that exam out of pocket. Also make note if your preventative benefit has any limitations or maximum payout. If you are going to the doctor for what you call a check up because you have been having some sort of symptom, this is not a preventative or well visit, so make sure your doctor does not code it that way.
About the Author:
Broker Jeff Cline is committed to helping individuals finding health insurance that fits your needs and your budget. He is a leader in Tx Health Insurance as well as most other States. Have Jeff Cline be your direct link to affordable insurance of any kind. Call anyday, all day toll free at (866)526-9669.
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