What Does a Copay Really Cover?

Health insurance is confusingHere’s a true story about two people who saw an orthopedic doctor.

In both cases the orthopedic doctor took a few x-rays and then consulted with the patient about the results.

Each had health insurance with a copay, but they were insured with different companies. The results turned out very differently.

The Copay Surprise

Person A – we’ll call him Chris – got a surprise bill a few weeks later. Turns out his copay only covered the consult, but not the x-rays. So he had to pay something in the range of $175-$200 (in addition to the copay he paid at the time of his visit).

Now, honestly, this is the most common copay structure for a visit like this.

But Person B – we’ll call her Karen – had a different experience. She never got that second bill because her insurance company (in this case it was BlueChoice Health Plan in South Carolina) has a “comprehensive” copay that covers almost everything that happens in the visit.

What Does Your Copay Actually Cover?

The point here is that not all copays are created equal.

(By the way, this is yet another reason you should talk to a health insurance pro who can help you make these distinctions [ahem], rather than calling some government hotline to get health insurance.)

Most copays don’t cover everything, but a few companies will offer a comprehensive benefit. Try to understand what you’re getting when comparing options.

And… just so you know… we can help with that!

Access Our Obamacare Open Enrollment Platform Here

How to Avoid a Copay

 In case you’re wondering, you may be able to avoid this copay mess altogether.

The American Medical Association (AMA) estimates that 70% of doctor office visits could be adequately handled with a phone call or, even better, a video web conference (similar to Skype or FaceTime).

And you can use telemedicine without a copay – 24 hours a day, 7 days a week (that’s when people your kids get sick anyway). It saves a lot of time and, obviously, the copay money.

You can get access to the best telemedicine network in the country for $9.99/month (for your entire household). Check it out:

Learn More and See How Telemedicine Works

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