Coverage for doctors visits

TA | January 9, 2009

Q: Please explain the $50.00 doctor visit in your value and silver plan. Does this mean I would pay $50.00 for each visit and would be allowed five visits? I am mainly concerned with the cost of a doctor visit. I have other health insurance but it does NOT cover office visits. I am looking for help paying office visits.

A: The numbers listed in the summary of benefits description for any mini-med health insurance policy indicates the amount paid by the insurance company. In this case the $50 indicates the amount paid to you regardless of the amount of the bill or other insurance. The amount you pay the doctor may be different, depending on the amount of the bill and any other coverage you may have. In your case, for example, the other insurance may not cover doctor's visits if the policy has a high deductible but it may reduce the amount the doctor is allowed to charge you under the provider agreement.

Consider this example of common doctor's office fees: The doctor's billed fee is $110 for a visit; the major medical insurance allows $80 for this PPO provider but the charge falls under the policy deductible; the supplemental insurance pays $50 so your net out-of-pocket cost is $30.

Consider Value Benefits, especially Value Med, Basic Health Insurance and Core Health Insurance for supplemental coverage of doctors office visits.


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