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MICHELLE MC GHEE M
What does it mean "$10 co-pay then 100%" in insurance language?
                     
 




Suzanne: YPA
Rating
This verbiage has two meanings, so you must be VERY cautious.

1) For HMO contracts, assuming you've stayed "in network," this means you're responsible for a $10 co-pay, then the HMO will pay the remainder of the bill.

2) For PPO or POS contracts, if a person has obtained care from an in-network physician, you will pay the co-payment (in your case, $10), then the insurer will pay the rest, according to its "allowed amount." Typically, you can't be billed for the amount over the "allowed amount."

For care rendered by an out-of-network physician, you will have a co-pay and a deductible or co-insurance. Then the insurer may (depending on the type of service that's rendered -- for example, emergency care) pay 100% of "allowed amount." Since a non-participating provider is not required to accept the insurer's "allowed amount," you CAN be billed for the remainder.

I recommend you ascertain which type of contract you have (HMO, PPO, or POS) and read through it so there are no surprises in the future.

I hope this helps.


highroad2mizery
You pay ten dollars every time you are going to be billed. For instance, every time you go to doctor, you will pay ten dollars and then the insurance company will cover 100% of the rest of the costs as long as they are covered in your policy. And make sure you check to make sure whatever you are getting done is covered by your insurance, otherwise you'll end up paying a lot more than $10.


Emily D
It means that you pay $10 for whatever service you are having done at the doctor's. Then your insurance will pay the rest, hence 100% of the leftover cost after the co-pay. Basically, this is really good insurance, because you are only paying $10.


mbrcatz
Rating
You pay the first $10, and the insurance company pays the rest.


HADITDUN
PAY $10 ,TO WHOEVER OR WHATEVER , AND YOUR INSURANCE PAYS REST. THAT'S REALLY GOOD INSURANCE. I'LL SAY THAT.


St N
You put up $10 on the initial claim and then the insurance company pays the rest of the claims in full, probably until the next calender year when the co-pay has to made again.


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