What does my PPO health insurance plan mean when it says “deductible plus 0% coinsurance for a doctor’s visit”? Do I have to pay the full amount of the deductible before I can start using the benefits?
This also means that as written in your PPO health insurance plan, once you meet the agreed deductible, the company will pay 100% of the charges for the whole year and you don’t have to pay for the con-insurance. Until then, you need to pay a small amount out-of-pocket for visits to doctors. However, some health care providers don’t know yet how much they should charge you for services until they receive the insurance claim. Upon filing the claim, you will receive an Explanation of Benefits (EOB) which indicates the actual doctor’s fee, charges for other medical services, the health insurance discount and other payables, if any. There are instances however, where you can use some medical services even if you haven’t paid the full amount of the deductible. There are times too, when the insured can use the benefits by just paying the coinsurance even if they haven’t paid the deductible in full. It all depends on the provisions of your health insurance plan. It is good to note that you have a 0% co-insurance. Coinsurance, also known as copayment, is the amount that you pay before the insurance starts paying. You must check if your PPO health insurance plan has a maximum out-of-pocket so that you can track down your payments outside of the deductible. Answer by general public — June 19, 2009 @ 3:54 pm No CommentsNo comments yet. Leave a comment |
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Yes. If your deductible in your PPO health insurance policy is $2,500, you need to pay it in full as scheduled. Only then can you charge the insurance company for medical and health services, doctors’ and dentists’ visits, prescription drugs and other services as indicated in your plan.
