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busymomonli
Resident Insomniac
Member since 4/13 2052 total posts
Name:
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Copays
If you're seeing a doctor who's office visit is $80,and your copay for a specialist is $75, does that mean the insurance company is paying $5 of your visit? Seems dumb. This is for mental health counseling, which my daughter will need weekly. How does one afford that? It's like a freaking car payment. Do these doctor ever work with you?
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Posted 5/17/18 7:45 AM  |
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PhyllisNJoe
My Box Is Broken
Member since 6/11 9145 total posts
Name:
Phyllis
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Re: Copays
Posted by busymomonli
If you're seeing a doctor who's office visit is $80,and your copay for a specialist is $75, does that mean the insurance company is paying $5 of your visit? Seems dumb. This is for mental health counseling, which my daughter will need weekly. How does one afford that? It's like a freaking car payment. Do these doctor ever work with you?
if they participate in your insurance, you pay whatever your copay is. I don't think insurance covers the rest, it's a set rate they have when participating in insurance.
When I used to go to Acupuncture, it was $60 per visit with or without insurance. So giving her my insurance card just allowed her to make more $ per visit. Doing that 2x a week was torture.
Yes, high specialist co-pays really do turn into a major expense.
Edited to add: No doctor I have ever seen ever worked with me on $
Message edited 5/17/2018 8:53:31 AM.
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| Posted 5/17/18 8:53 AM |
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jamnmore
LIF Adult
Member since 6/16 989 total posts
Name:
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Copays
Copays are contracted amounts between the provider and insurance company. They are contractually bound to accept that fee and unfortunately lowering it would be a violation of their contract.
Message edited 5/17/2018 10:18:31 AM.
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| Posted 5/17/18 10:18 AM |
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Chai77
Brighter days ahead
Member since 4/07 7364 total posts
Name:
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Re: Copays
Posted by jamnmore
Copays are contracted amounts between the provider and insurance company. They are contractually bound to accept that fee and unfortunately lowering it would be a violation of their contract.
This is correct. And yes, if the contracted rate is $80 and your copay is $75, then the insurance company would be paying the $5 difference to the provider directly.
If your copay is $75, that is the highest I've ever heard of, that is not coinsurance in a deductible plan. Ask the provider if he or she has an out of pocket sliding scale, which may come out to be lower. Meaning you are bypassing insurance all together, so they can charge what they want and could potentially work with you like that.
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| Posted 5/17/18 10:24 AM |
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mrsrainbow
LIF Adult
Member since 1/17 1465 total posts
Name:
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Copays
A doctor will work with you if you pay OOP, not through insurance. They usually offer a sliding scale for self-pay, but it still might be more than the copay itself. It's not cheap.
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| Posted 5/17/18 10:25 AM |
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MarathonKnitter
HAPPY
Member since 2/07 17374 total posts
Name:
EMBRACING CHANGE
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Re: Copays
mental health is the worst when it comes to affordability.
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| Posted 5/18/18 9:42 AM |
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LSP2005
Bunny kisses are so cute!
Member since 5/05 19461 total posts
Name:
L
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Re: Copays
Oh wow, that is high. I am really sorry. I would ask the doctor what he charges for self pay or look around for another Dr for self pay. Just so you know, I know one other person with a $200 copay, so while yours is really high, it is still not the worst.
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| Posted 5/18/18 11:29 AM |
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lightblue
LIF Adult
Member since 1/17 2249 total posts
Name:
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Re: Copays
Yeah they pay whatever the difference is between your copay and the contracted rate.
My DD recently got a stomach xray, I had to pay $20 and my insurance company only ended up paying like, $6 because the contracted rate was $26.
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| Posted 5/18/18 2:20 PM |
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