this post was submitted on 12 Sep 2023
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[–] bustrpoindextr@lemmy.world 21 points 1 year ago (2 children)

If you had no co pay you wouldn't have had a $200 bill ( unless you went out of network and then fuck you for wanting to have a choice)

[–] abraxas@sh.itjust.works 13 points 1 year ago* (last edited 1 year ago) (2 children)

Found the European (or just someone young who doesn't know much about typical insurance shell-gaming).

You have no copay, but most insurance plans include any non-preventative visit in the deductable. That means you are responsible for 100% of the bill until your $1500/yr deductible (in as low deductible-plan, a LOT higher in most plans) is reached. To look like they're actually doing something, they treat the negotiated rate from the doctor's MSRP as a "discount" (the doctor says $300, the insurance negotiates you to $200). The really ugly irony of that, is that if you were uninsured, many offices would have given you an NP for $70, and some have an "uninsured rate" of like $150.

[–] ChamrsDeluxe@lemmy.world 3 points 1 year ago (1 children)

My deductible with that company was $5000 lmfao! Who the fuck is going to ever meet that in a year!?

[–] abraxas@sh.itjust.works 3 points 1 year ago (1 children)

And the irony is that anything not covered (like your responsibility on a coinsure) does not apply to the deductable. Nor do copays.

Literally the only thing left is "Maximum Out of Pocket", but they even have ways around that.

[–] ChamrsDeluxe@lemmy.world 1 points 1 year ago

With the insurance I have now through my company, I already met tge deductible and haven't been charged extra for anything. It's really nice!

[–] bustrpoindextr@lemmy.world 1 points 1 year ago* (last edited 1 year ago) (1 children)

I'm both American and have been on multiple different insurance plans. (Including a no copay plan)

No copay means no copay, what you're describing is not no copay.

https://www.tuftsmedicarepreferred.org/healthy-living/what-difference-between-copays-deductibles-and-coinsurance#:~:text=Copays%20cover%20your%20cost%20of,time%20you%20visit%20your%20doctor.

[–] abraxas@sh.itjust.works 4 points 1 year ago* (last edited 1 year ago) (1 children)

No copay means no copay, what you’re describing is not no copay.

Yes, "no copay means no copay". Most insurance plans have BOTH a copay and a deductable on a large number of higher-end services like inpatient surgery and the diagnostics like CT. And I have had, and helped family shop for, healthcare plans that have no copay, but still have a deductable. Further, there's a lot of PPO variants that have no copay or deductable, but have a coinsurance for everything.

In my adult life, I have never seen a plan where your "typical" out of pocket for anything other than Primary Care or Teledoc was anywhere near zero, even if those plans approach $3000/mo.

And you're right. What I was describing was not a copay, but a deductable (please check the words I used, as I called it a deductable :) ). For a patient, money going out feels the same as money going out. Especially in large quantities.

[–] bustrpoindextr@lemmy.world 1 points 1 year ago (1 children)

And you're right. What I was describing was not a copay, but a deductable (please check the words I used, as I called it a deductable :) ).

Sure but the conversation was about copay ;)

[–] abraxas@sh.itjust.works 3 points 1 year ago* (last edited 1 year ago)

Sometimes conversations get confused pretty quickly in thread format. I never understood why, but it IS hard to keep context in Lemmy. Let me reopen with what I was replying to:

If you had no co pay you wouldn’t have had a $200 bill

That's what you opened with. The person above you didn't use the word "copay" at all. They just complained about being charged $200 to get a note. Your reply was the quote above. My reply was "but most insurance plans have a ... deductible".

The conversation was really about money out of pocket. I think you inadvertently thought it was about copays. It happens :)

[–] ChamrsDeluxe@lemmy.world 3 points 1 year ago

Nope, in network, that's just how their insurance worked.