Question

Your health insurance requires a copay of $45 each time you see your doctor. You have already met your $1750 deductible for the year, but you are far below your out- of-pocket maximum payment of $4000 for the year. Your doctor charges patients without insurance $100 per visit. How much must you pay for your visit to the doctor in this situation? Your Answer:

Answer 1

Answer:

1. Copay -

Copay is the fixed amount paid by you, every time you go to the doctor for consultation or medical prescription.

It covers a portion of the per visit fees of the Doctor and the rest amount is paid by the insurance company.

In the above question copay is $45 which is 45% of Doctor per visit fees of $100.

2. Deductibles -

Deductible is the cut off amount, patient need to pay before the insurance company begins to pay.

For example:

If the health insurance has deductibles as $1000, then you need to pay the $1000 deductible before your health plans kicks off.

3. Out of pocket maximum -

This is the maximum amount after which any further medical expense is born 100% by the health insurance company.

The out of pocket expense minus deductibles is eligible for coinsurance or copay.

calculation:

Deductibles is $ 1750 which has already been met and out of pocket maximum payment is $4000,

so

The left over i.e $(4000-1750) = $2250

is eligible for copay and copay is $45,

so

Number of visit = 2250/45 = 50 visits