医疗报销, Copay 和Deductible 是什么关系?

d
disneyfl
楼主 (北美华人网)

之前从来没有过reach deductible, 感觉copay 一直都算在 deductible里, 上半年保险aetna 是这样,好几个bill , 有几个copay 60刀, lab,小手术,还有药,都没有reach deductible. 也没有一次性把deductible 都用掉。
下半年失业,换了公司的BCBS, 第一个bill, OB B超,Copay 15 刀,然后保险直接让付 deductible 500刀, 直接把deductible 用完了, 然后之后的visit copay 还是要单独付。我就有点迷茫了, 感觉之前都不是这样付的呀。还是我之前理解错了,有人能帮忙解惑一下吗?

a
aiyamayayongle
Copay 基本等于挂号费, deductible 就是自付段,两者没有密切关系。
i
iammaja
楼主只是付完了deductible ,又不是付到了out of pocket max的额度,copay还需要继续付,有啥不可理解的,是不是把deductible 和out of pocket max的意思搞混了?
h
hioc
还有coinsurance,直到 hit Max out of pocket
w
wenqing2011
没啥关系吧,而且copay不算在deductible的.
金银岛
。。。
d
disneyfl
回复 6楼 金银岛 的帖子
是PPO, 我们PPO保费更贵哦, 想保HMO的,但是OB只接受PPO
金银岛
。。。
b
bye2020
Max out of pocket包括out of network吗?就是oon花了十万mop6000的话,保险会付九万四吗?
t
tiffanylee
你只有付完了deductible,保险公司才会开始cover
s
sleepykittie
Most services covered by your plan are subject to deductibles, as outlined in your policy terms. If the service isn’t covered, you’re typically responsible for the full cost — regardless of whether you’ve reached your deductible or not.
There are some types of care that don’t require you to meet your deductible before your provider covers the cost. Typically, routine exams, cancer screenings, and other types of preventive care are fully covered.
Resource: https://www.metlife.com/stories/benefits/deductible-vs-copay/#:~:text=Key%20takeaways,always%20count%20towards%20your%20deductible.
常规看医生 (preventive care)只需copay,即使你还没到deductible
m
mylittle9
bye2020 发表于 2024-10-06 12:30
Max out of pocket包括out of network吗?就是oon花了十万mop6000的话,保险会付九万四吗?

In net work 和out of network是分开算的。各有各的max out of pocket, 而且不重复计。
一般out of network的要高很多。