Health insurance question

ASmallWonder

@whocanitbenow (or anyone else in the know)

We switched insurance plans in January and I read and read and THOUGHT I understood our plan but I either didn't or they're screwing something up (in our favor, which is why I don't want to ask them directly lol).  Our plan said it had an $1800 a year (family) deductible.  Co-pays didn't count toward meeting the deductible and well visits were covered in full.  That would mean if I bring a kid in for a sick visit and give them $30, I would expect to see a bill for the rest of the charges, which would be denied by my insurance until I had paid out $1800 in the year, right?  Well, we've had 3 sick kid visits so far this year and for every one I've paid the copay and then I get the EOB from my insurance and it shows my balance as zero.  I have not received any bills from the pedi's office either.  So tell me - am I not understanding something or are they screwing up (meaning I should be prepared for them to find their mistake and make me pay at some point)?

ASmallWonder

WhoCanItBeNow said:

That's correct. When you have a copay you are not subject to the deductible. Office visits almost always have a copay and if you have procedures done, then it goes against your deductible and co-insurance rates once that is hit.

Ok so I DID misunderstand.  I thought any and all charged services up to $1800 were going to be my responsibility.  But you're saying that it doesn't apply to office visits?  That's interesting (and good lol).  What about an ER visit?  Quinn had to go last week and I'm waiting to see that bill.

ToastieSimons

It all depends.  Do you have co-insurance also?  or just a deductible and co-pays?  Because if it's a deductible and co-pays I would assume all office visits would be covered under the co-pay.  If they run certain test, take x-rays, procedures, etc those would be subject to your deductible.

if you had co-pays and co-insurance you would pay your co-pay plus a portion of the remaining bill.

Health insurance is a bitch when it comes to understanding.

ASmallWonder

ToastieSimons said:

It all depends.  Do you have co-insurance also?  or just a deductible and co-pays?  Because if it's a deductible and co-pays I would assume all office visits would be covered under the co-pay.  If they run certain test, take x-rays, procedures, etc those would be subject to your deductible.

if you had co-pays and co-insurance you would pay your co-pay plus a portion of the remaining bill.

Health insurance is a bitch when it comes to understanding.

It so is.  I spent so many hours making sure I understood our options and here we are, months later and I'm still confused lol  Of course, better to be confused in a way that costs me less money so I'm thankful for that.