Find solution
Pre-payment of Medical deductible. How does this work?

Basic questions on medical premium/deductible for work?

  • Ok so I have my first job and still a little confused about health insurance lingo and such. My deductible is $250 and I understand that throughout the year that means that whenever I go to see a doctor, etc. it will come out of my pocket until that $250 is up, correct? Then to my understanding, insurance kicks in and starts paying roughly 80% of it and I am responsible for 20%? I understand that much but on my insurance card...what do these items mean right above my deductible? BTW, I have Blue Cross and it's a PPO Program. Plan PCP $20 SPEC $20 ER $50 How does that fit in?

  • Answer:

    When you visit your primary care physician, you pay a $20 copay. When you visit a specialist, you pay a $20 copay. If you go to the emergency room, you pay a $50 copay. Sometimes, once you've visted them enough to pay the $250 in charges, and you need to see them more, then you pay $20. Sometimes the coinsurance doesn't apply to office visits. If you have any testing done, or any procedures, or operations, or any hospitalizations, you pay 20%, until you reach the "maximum out of pocket" amount. You have a FANTASTIC insurance plan.

jagsfan0... at Yahoo! Answers Visit the source

Was this solution helpful to you?

Other answers

The co-pay for the Primary Care Provider (PCP), a Specialist (SPEC) and the ER is not subject to the deductible, meaning the first time you see your primary doctor all you'll pay is $20. For items that are subject to the deductible, which would be inpatient hospital and possibly some outpatient procedures (depending on your plan) you'll first pay the $250 and then you'll pay 20% or whatever the percentage is. There will be a cap to that 20% though and you can find this information out by reading the information provided or calling customer service.

Zarnev

You need to either speak to your HR department or whoever handles your benefit, since every plan is different. You may have what is known as a "first dollar benefit" plan, which means that you pay the $20 co-pay when you go to your family doctor and that's it. A basic plan has co-pays for doctor visits and then the deductible/coinsurance when you do things like ER visits, hospitalizations, chiropractic, etc. Go to someone in HR or benefits and ask them. You should have received a "Specific Plan description" when you were hired which will explain all of this as well. Good luck!

katiesquilts

After you meet your deductible (which you are right about) then visits to your Primary Care Physician (PCP) are $20, Specialists are $20, and the ER is $50, which is often waived if you are admitted. The 80/20 is your hospitalization. It's a roll of the dice. If you're a generally healthy guy it should be ok. Otherwise that 20% can add up fast!

Janet Pierce

Related Q & A:

Just Added Q & A:

Find solution

For every problem there is a solution! Proved by Solucija.

  • Got an issue and looking for advice?

  • Ask Solucija to search every corner of the Web for help.

  • Get workable solutions and helpful tips in a moment.

Just ask Solucija about an issue you face and immediately get a list of ready solutions, answers and tips from other Internet users. We always provide the most suitable and complete answer to your question at the top, along with a few good alternatives below.