An office visit co-pay can be a bit misleading. They are different depending on the type of health insurance plan you are on. A PPO co-pay works differently than an HMO co-pay. Most California health insurance companies offer PPO's with office visit co-pays, while some companies do not even offer HMO plans at all.
So, what is the difference? Take a Blue Cross of California HMO plan with a $20 office visit co-pay. Generally when you go to a physician or specialists office, whatever is performed in the office the physician charges will be covered by the plan co-pay, including if you are sent for lab work or an X-ray. When you go on an appointment whether it is for the flu, an annual check up, or you sprained your knee hiking. You can be certain your costs will not be much higher than the co-pay itself.
Now, for the PPO co-pay. For example, your plan has a $1,500 annual deductible with a $30 office visit co-pay. When you visit the doctors office, as a rule of thumb, you will pay everything towards your deductible except for the opportunity to meet with the doctor. If you need an immunization, or a blood test, or even an X-ray, these costs will most likely be out of pocket expenses which you will pay towards your deductible.
If a physician charges $120 for an office visit that means you will be charged $120 just to make the appointment. If you have an office visit co-pay, the $120 charge will be knocked down to whatever the co-pay benefit amount is.
So why choose a PPO style plan? A couple reasons; first of all the monthly premium will most likely be much less. PPO plans offer freedom of choice with physicians, specialists and hospitals. If you see a provider within the specified network your costs and coverage will improve. Anthem Blue Cross of California and Blue Shield of California for example, have close to 50,000 providers in their PPO networks.
Look at the 'freedom of choice' benefit for a moment. If I, my wife, or one of my children has an accident or major illness, the last thing I want is to be locked into a small physician network. If I want to go to Stanford Hospital or UCLA Medical Clinic, or to a specialist who I think can treat our condition the best; I make an appointment, and go. That is it. It is up to me! I do not have to deal with a referral or if my primary physician or the medical group allows me to go outside of the predetermined medical group for care.
The PPO office visit co-pay may not be as comprehensive compared to the HMO office visit co-pay, but the PPO plan is of much greater value to me and my family.
I have been assisting clients for over 20 years in the Health Insurance and Medicare Supplement market.
I live in Sacramento with my wife and three children, and offer my services throughout California, Nevada and Colorado. When I'm not busy helping clients, I'm usually fixing my kids flat tires, helping with homework, or fighting with my backyard vineyard.
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Anyone who has ever needed extensive medical treatment either in a doctor's office setting or hospital knows the cost is expensive. Although most people who live in Virginia rarely have to see a doctor, having adequate health insurance is very important. Even though the level of coverage is the driving factor behind which health insurance company they ultimately go with, cost also factors in for most people. Getting affordable health insurance in Virginia can be done if you know what to look for.
Pregnant women without insurance in Virginia have a great resource at their disposal. Many pregnant women struggle trying to make ends meet and are working at low paying jobs that offer no health care benefits. For them they can access a program in Virginia called FAMIS Moms. The program's focus is on expectant moms who don't have health care and it enables them the opportunity to see a doctor early and throughout the duration of their pregnancy.
There are many other people in the state who also need affordable health insurance and they don't qualify for any of the state assisted plans. There are ways for them to save money when shopping for health insurance and they include:
• Removing college age kids from the policy. Many colleges now offer health care insurance to students. If this is an option at your child's school utilize it as the premiums are often lower.
• Pay a higher deductible. Although this will increase the cost of your out-of-pocket expenses it will drive down the premiums. It's a good approach as it generally saves money.
Also try and retain health insurance before you become really ill. Obviously this isn't always possible, but people who have pre-existing conditions always pay more in premiums than those who don't therefore buying now, if you are healthy, is a great choice.