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Makayla Anne due 2/23/2009! | Health insurance benefits...deductible?? |
Ok I need help explaining health insurance to me. My husband and I (and our son) receive insurance through my husbands work. We have a $400/individual deductible and $1000/family deductible (I guess we would go by the family one??) I also have a $25 office visit co-pay. Now I am looking to see a therapist for some personal issues I am having....Am i going to have to pay the $1000 before my insurance starts working or do I pay the co-pay?? Im not really sure how this all works.
Also...everytime i pay a co-pay does that go towards my deductible?? I guess it doesnt matter to much considering the year just restarted but I was just wondering.....thanks to anyone that can help! |
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Zarnev
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For the deductible, each person will have the $400 deductible but the entire family pays toward the $1000 deductible. For example, you have medical expenses and you pay the $400. You will no longer have any deductible for the rest of the year and your $400 goes toward the $1000. Then your husband has medical expenses and pays $400. You have now paid $800 toward the $1000 so if your son has expenses he'll only have $200 to pay.
The office visit co-pay will depend upon the policy. With most policies the office visit is not subject to the deductible so you'll just pay the $25. The $25 will not go towards the deductible. Some policies will have you pay the deductible first but these are generally rare with group policies. Other types (such as an HSA) also have you pay the deductible first but since these generally don't have a set office co-pay I doubt you have this type.
Most policies have limits and higher co-pays for therapy so you better check the policy first. |
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mbrcatz
 |
You have to pay $400 before the insurance kicks in, and then $25 every visit.
Copays do NOT go to your deductible. YOu pay the deductible first, but you pay the co pay every time. |
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sarah314
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$400 is the most that an individual person in your family would pay in deductible for the year. $1000 is the maximum total family deductible for the year. (Since you have 3 people in your family, rather than potentially be liable for $400 X 3 = $1200, they cap the family deductible at $1000.)
Copays do not count towards deductible. They are 2 separate things.
Quite often, services that have copays (like office visits) are not subject to the deductible. You would have to ask your insurance company whether that's true on your policy. (What this means is that, for example, on a medical doctor's office visit w/$25 copay deductible wouldn't apply for the actual office visit charge. You'd pay your $25 and the insurer would pay the rest on the office visit, even if your deductible wasn't met. Other charges done at the office visit like lab work and x-rays could still be a part of your deductible though.)
You really need to call your insurance company to verify your benefits for outpatient mental health. Just because your doctor's office visit copay is $25, doesn't necessarily mean that you'd have a $25 copay to see a therapist. Those 2 benefits can be set up differently. (Example, you could have a $25 copay for a medical office visit, but only be covered for 80% after deductible for outpatient mental health.) The insurer will be able to confirm exactly what your benefits are...they can also let you know of any limitations (i.e. - only X number of visits per year for outpatient mental health, etc.) and confirm that the therapist you want to see is part of your network. |
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JaredBalis
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Typically, co-pays will not go toward your deductible. As far as the mental health, some plans will cover that will co-pays and some will make you pay for the services until you reach the deductible and then have coverage, sometimes limited (50% coverage, or limited visits per year). Some plans in my state (Utah) won't even cover mental health. I hope that helps.
For free health insurance quotes, and to connect with a local agent who can help you through this, fill out a quote form at http://www.myinsurancequotes.net.
I hope that helps!
Jared Balis
http://www.utahinsurance.org |
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HC Investigator
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there could be a lot of variables to your question but seems like the most common would be you pay your $25 copay only if the practioner is in your network. Your deductible probably accounts for services outside of the office setting. |
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