Billing and Payment: Co-Pays and Deductibles Are Due Prior to Service

                   Co-Pays and Deductibles

The new health care system can be confusing. But if you have ever had private insurance in the past—as most probably have—you should remember that it is pretty much the same as before. In many cases, for example, the payment structures are similar in terms of co-pay and deductibles.

For example, whenever you visit your doctor your co-pay and your deductible are due at the time of service. You do not have to make any payments when you make the appointment but when you check in for your visit you will have to cover the co-pay. Typically what will happen is that the hospital (or clinic, or wherever you are attending) will bill the insurance company the deductible. Which in turn you will be responsible to pay either to the provider or the insurance company.


That is important because every insurance plan has a deductible. This is the maximum amount of money that you are required to pay every year for services. So if your deductible is $500, then you only pay up to that much in a year’s time and your insurance will pay the rest. Generally, your insurance company will cover whatever this cost is per visit and then you make your insurance payments accordingly. Sometimes the insurance company will only pay a portion of the cost per visit and apply this to your deductible. You will be responsible to pay the balance owed to the provider of services.


In terms of the co-pay, though, you will be required to make a payment the day of the appointment. This is always a far more reasonable amount of out-of-pocket money—something like $30, depending on your policy—which you cover immediately.

Keep in mind too, though, that while you do not have to pay anything to make an appointment, your hospital might charge a fee for not showing up, so if you need to cancel or reschedule simply make the call and do so. Always know what your doctor’s policy is regarding cancellations and rescheduling.