Understanding Your Health Insurance Deductible

January is the time when most people see their health insurance deductibles start over.  In many cases, people will postpone or forgo medical care because they are concerned that they will have to pay a large bill until their deductible is met.

One thing to be aware of if you do have a large deductible is what the contracted rates are that the insurance company pays to your doctor for visits.  For example, your doctor may charge $55.00 for an adjustment, but the contracted rate that the insurance company will pay is $35.00.  The $35.00 is the amount that the doctor has agreed to accept if you have this insurance.  So whether you are paying for the visit, or the insurance company is paying for the visit, the amount due is still $35.00.

If your insurance charges a co-pay for doctors visits, the difference between your co-pay and the cost applied to your deductible may not be very much.  Many insurance companies now have a $30 co-pay for doctor’s visits, so even if your deductible has not been met, the additional $5 per visit should be affordable.

If your insurance company pays a percentage of the contracted rate, again the $35.00 is the maximum that the doctor’s office can collect.  If you have 80/20 coverage and
your deductible has been met, you would typically owe $7.00 for a visit.  If your deductible has not been met, you would owe the $35.00.

Our office has more than 25 years of experience dealing with insurance companies and different health plans.  If you would like to be treated, but have questions about what your out of pocket costs may be, please feel free to contact us.