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What is your copay for doctor/pediatrician visit?


momacacia
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Well check (1 per year with no labs) is free. Labwork is billed at 20%, no copay.

 

Sick visit, regular doc (mental health included) is $35.

 

Specialist $50

 

Urgent Care $100

 

ER $200

 

Therapy (physical, speech, occupational) is 20%, no copay. Limited to 26? each per year.

 

We used to have good insurance; it's been getting worse. Every year our deductible and co-pays rise a little. 

Edited by beckyjo
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How much does the insurance cost you?

 

It's not separate insurance - it's paid by national tax.  I pay tax of 20% on everything over about the first USSD13,000 of income.  Sales tax equivalent is 20% (not on food or children's clothes or books).  Tax on petrol is big.  That's it.

Edited by Laura Corin
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$25 for an office visit, and then a % on anything that falls under the deductible, until we've paid the max per person ($2500) per year, or the max per family (I think $6000) per year. It's supposed to be 20%, but recent bills have shown that not to be exactly the case; the provider submits the bill to the insurance, the insurance replies with "we'll allow x, and pay y" and everything else falls to us. Sometimes the reduced price (what they billed minus what the insurance "allows") is less than the supposed "80%" of what they'll cover, then they pay some amount, then we pay. All I know is we end up paying A LOT for these things, with the insurance "payment" being much less than ours, unless the provider is simply not showing us the full statement. 

 

I think it's $40 for urgent care and $75 for ER. 

 

"Falls under the deductible" includes lab work, any imaging other than x-ray, biopsy, etc. Basically, anything that your doctor might need to do to find out what's wrong with  you, if it involves more than him, a BP cuff, thermometer & stethoscope. 

 

(and we pay a few/several hundred per month for this as well)

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It's not separate insurance - it's paid by national tax.  I pay tax of 20% on everything over about the first USSD13,000 of income.  Sales tax equivalent is 20% (not on food or children's clothes or books).  Tax on petrol is big.  That's it.

 

Ah ok.

 

I only ask because once my husband went on and on about the cost of our copays and preimiums.  When we compared numbers it turned out it wouldn't really be cheaper in Germany.  One would be better protected financially from high costs of care, but the premiums were higher than what we have but the copays lower.  So it wasn't ultimately a huge difference. 

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$25 for uncomplicated visit with pcp, full bill for the rest until I get the deductible met, so a hundred or so. After that it's 20% until I meet the max on the coinsurance. 

 

Maybe this is what ours is, and the 80/20 split only falls in after the deductible, and before the max. That makes not a lot of sense to me (our deductible is pretty close to our max out of pocket), but fits what's happened thus far. 

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For primary care, $15 for an office visit and free for a well visit if they are in network. Local walk-in clinics are also $15.

 

Specialists are $25 if they're in network. 

 

We're finding that more and more is out-of-network, which is a significant issue for us because we have a family member who needs certain specialists, period. We paid quite a bit more out-of-pocket in 2016. I'm figuring that 2017 will be even worse (sigh). 

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We pay $25 for primary care and mental health.  $50 for all other specialists.  Well visits are free including bloodwork.  $1000 deductible per person, $2000 for the whole family.  The first $1000 per person is covered before we have to start paying the deductible.  Once the deductible is met, we pay 10%.

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We don't have a copay for a well child visit. For a sick visit, the copay is 20% (about $20) after the $6,000 deductible is met. DS usually only has one sick visit per year - so we pay about $100 each year for sick visits. Now that ds is in college, he goes to student health. We pay a $150 per semester health fee and he has no charge for sick visits, prescriptions and most lab work. We keep him on our policy to cover specialist appointments (nephrology) and hospitalizations. 

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We don't have copays, well child visits are free. Sick visits are $100-120, labs are more. I don't think we have high deductible insurance, it's $2000, which is the deductible we have had for years. We do have an HSA and are given the first $1000 bu my husband's employer each year.

 

ETA we currently pay next to nothing for premiums. In the past it has been over $1000 per month but my husband has changed jobs and we now pay around $15 per month which is a fabulous deal.

Edited by Rach
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I know it is not what you asked, but our high deductible well-child copay is $0.  

Same with any annual physical for anyone on the policy.  

 

Our deductible is $10,000

 

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Our children's pediatrician does not accept insurance so we pay for the entire visit upfront and then submit to my husband's insurance for reimbursement for an out of network provider. Generally depending on the visit we pay somewhere between ten and thirty five dollars once we deduct what the insurance reimburses us.

 

If you're more interested in insurance specifics we have our family covered under two different plans:

Plan A [Purchased by DH's law firm covers our family, his associates/family, and their staff (secretary/paralegals)/family.]

*Primary Care Copay 25

*Sub-Specialist Copay 50

*Emergency Department Copay 100

*Individual Deductible 500 Family Deductible 1000 We have 10% Coinsurance after the deductible. 

This is technically for in network providers but we have yet to find anyone who takes commercial insurance and is not in network. Our children have had subspecialty care at four different children's hospitals in three different states which have all been in network. They also reimburse quite well for out of network as you see above. This is actually good insurance because when my husband started back at his firm and wanted to offer insurance to his employees and families he wanted to offer something they could use. You pay for what you get to an extent though and if ACA holds up he will likely be hit with the cadillac tax so I'm not sure how that will change what they do for 2018.

 

Plan B [My hospital provides this to all employed physicians (and other employees) and their families. It is kind of a self insured plan with a catastrophic rider but all insurance costs are born by the hospital so perhaps I completely concede/accept a little bit of you get what you pay for]

*In network Family Medicine 10

*In network Specialty (Including Ob, IM, Pediatrics and all subspecialty) 30 

*In network ED Copay 100 (but waived for admission)

*Individual In network Deductible 200 Family In network Deductible 500. No coinsurance. 

This is actually great for anything which can be covered by our hospital and to be fair we do have 24 hour cardiac cath/CV surgery. are a stroke center, a trauma center, have PICU/NICU etc. If we didn't have children that see some pediatric subspecialists I might be ok with just covering the whole family on this plan. But we do. 

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Are the premiums on these plans really high?

 

Ours is a high deductible plan (we pay 100% up to 6000, then pay 80/20 to $8000). My DH's employer does give him a traditional insurance option, but the outrageous premiums  mean the high deductible plan would be far smarter financially for all or nearly all.

 

I feel frustrated sometimes because my husband and I tend to avoid the doctor when we shouldn't, for ourselves, not the kids, due to the high costs. Our insurance gets worse every year, and DH is in a state employee pool--its really huge.

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Zero for well child and whatever is covered for adults annual as stated in the company health insurance policy.

$20 out of pocket per sick visit, labs were covered and we pay for any prescription drugs. Ours is Blue Cross Blue Shield California and family premiums are high out of each pay check but I forgot how much, defiantly over $300 from our side and employer pays more to top up. So about $1k per paycheck if you add our contribution and employer contribution to the premiums.

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