The doctor might bill you $350 for that office visit. He checks you out, prescribes some medicine, and you go home to get better.
For example, say you've got a bad case of the flu and you go to the doctor for an office visit. The last thing that is important to know about medical bills with insurance is that you wait to see the "insurance adjusted amount" before paying. Once the OOP limit is reached, the insurance company takes over 100% of the charges. If your OOP limit is $10,000 then once you've paid your $1,000 deductible and enough copays to have paid $10,000 in medical charges, you stop making copayments too. The out-of-pocket limit is the maximum amount you'll pay in a policy year. This is kind of like "sharing" the charges with your insurance company and applies to every bill until you've met a third number that you didn't mention - the out-of-pocket limit. Keep in mind that depending on the kind of visit, there may be multiple copay amounts due. In other words, if you end up paying $700 for your bills and your wife pays $300 for hers, you will have met your deductible.Ī copay is an amount that you pay AFTER you've met the deductible for each medical charge. In your case, it's likely the $1,000 is for both of you. When you have a medical bill, if you haven't paid an amount equal to your deductible, you'll pay 100% of the charges.
The deductible is the amount of money each year that the insurance company will make you pay first. Each plan is a little different but in general, this is how they work.
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