California Health Insurance Office Copays
Office Copay
Office copay is one of the main components of the benefit summarie you will see when you get instant health quote. With most plans on the market, you will pay a fixed copay for the office visit consultation. For example, you may see "$30" under the office visit column. This usually means that you will pay $30 when you see a doctor.
What is covered by the office copay
The copay only covers the office visit consultation itself. If the doctor requests labs or performs other procedures (such as a podiatrist preforming wedge resection surgery on an ingrown toenail), that procedure is usually not covered under the office copay. It will either have a separate copay (typical with HMO's); be subject to a plan deductible; or subject to co-insurance percentage sharing. Labs are also in addition to the copay amount you pay. Usually there is a flat copay amount for general physicians and specialists on the California health insurance market. An exception to this "copay only for the consultation" rule can be found with the Tonik health plans from BC Life and Health (Anthem Blue Cross). Tonik plans were designed to make the office copay more inclusive. You can run an Individual Family health plan quote and check the Tonik benefits to compare. The office visits usually do not make a distinction between the type of doctor...specialist or general practice physician.
How are routine physicals handled with office copays
Physical exams are usually handled separately from standard office visits. Depending on the health plan, they may have a similar copay but they may also be subject to the main deductible. Some carriers such as Anthem Blue Cross may require certain providers for routine physicals. It's important to look at the benefits of your particular health plan you are looking at to see how it treats routine physicals. You may have an office copay for the routine physical but resulting labs such as blood panels may be handled separately.
Some health plans offer no or limited office copays
Anthem BLue Cross offers health plans as part of an ongoing trend to reduce health care costs that do not offer office copays or have a fixed number of them per year. The HSA qualified or Health Savings Accounts plans typically apply office visits to the main deductible. This usually means you will pay the full discounted PPO rate (if in-network for covered benefits) for doctor visits until you meet the deductible. There are other hospital plans (for catastrophic coverage) that usually do not cover office visits. Other plans limit the number of office visits a person can have in a calendar year. Once you use your number of office visits, you will usually pay the full negotiated rate or a percentage of the negotiated rate for covered benefits, in-network.
Office visit copays and network consideration
With a PPO plan, your choice of providers can affect your out-of-pocket expenses. The copay shown in your health quote usually refers to using in-network doctors. If you use out-of-network providers, you will usually pay more out of pocket than just the in-network copay. With HMO's, you want to work through your Primary Care Physician and HMO medical group. Usually with HMO plans, you will no benefits outside the scope of your PCP or medical group.
