{"id":2567,"date":"2014-12-16T11:00:25","date_gmt":"2014-12-16T15:00:25","guid":{"rendered":"http:\/\/www.hnetalk.com\/Member\/?p=2567"},"modified":"2014-12-16T11:00:25","modified_gmt":"2014-12-16T15:00:25","slug":"deductible-or-copay","status":"publish","type":"post","link":"https:\/\/hnetalk.com\/member\/deductible-or-copay\/","title":{"rendered":"Deductible or copay?"},"content":{"rendered":"

It\u2019s Saturday, and Sally received a bill from her dermatologist for $123.00. Why? She paid the $30.00 copayment at the time of the visit. First thing Monday morning Sally called the insurance company to ask why it was not covered. All she knows is that she went for a skin exam so that he could check her for moles and skin tags. While in the examination room, a mole was removed. Well, it turns out that Sally has a $500.00 deductible. The mole removal is considered an outpatient ambulatory procedure. This procedure was provided in addition to the office visit. The provider can bill for both services. The claim for the services will be processed according to the member\u2019s benefit plan. The charge for the mole removal was applied to her deductible – which means Sally is responsible to pay the dermatologist the $123.00. She still has $377.00 until she meets her annual deductible.<\/p>\n

\"deductible-vs-copay\"<\/a>Confused? Not all services and procedures are subject to deductible. The quickest way to see if a service is subject to your deductible is to look in your Explanation of Coverage (EOC). If you do not have your EOC, your current plan information is available on our secure web portal, HNEDirect: (http:\/\/www.healthnewengland.com\/Membership\/HNE_Member.html<\/a>)<\/p>\n

In the Appendix to your EOC is a chart labeled SUMMARY OF YOUR PAYMENT RESPONSIBILITIES<\/em>. The annual deductible amount is listed at the top of the chart. Sally\u2019s deductible is $500.00 for an individual and $1,000.00 for the family, but your amounts may differ depending on your benefit plan. If you have an HMO plan, the middle column will tell you whether a service is subject to your deductible.<\/p>\n

Keep in mind that copays do not count toward the deductible and the deductible resets annually. Depending on your plan, this will happen either on your group\u2019s renewal date or on January 1.<\/p>\n

It is also important to remember that the terms \u201croutine\u201d and \u201cpreventive\u201d are not the same. Not all services that you receive regularly are preventive. For example, you may have a medical condition that requires an additional diagnostic test when you have your annual eye exam. Because of your condition, this test is routine for you. But the test is not a regular part of an eye exam for someone who does not have that condition. In this case, a copay would apply to the visit because the diagnostic test done is not part of the preventive services that everyone would receive. Remember if you are not sure about your benefits, the Member Services staff can be reached at 413.787.4000 or toll free 800.842.4464.<\/p>\n","protected":false},"excerpt":{"rendered":"

It\u2019s Saturday, and Sally received a bill from her dermatologist for $123.00. Why? She paid the $30.00 copayment at the time of the visit. First thing Monday morning Sally called the insurance company to ask why it was not covered. All she knows is that she went for a skin exam so that he could […]<\/p>\n","protected":false},"author":1,"featured_media":2691,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[34,19],"tags":[68,180,189],"class_list":["post-2567","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-dec2014lw","category-newsletter","tag-deductible-vs-copay","tag-health-new-england","tag-hne"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/hnetalk.com\/member\/wp-content\/uploads\/2014\/10\/deductible-vs-copay-e1414609903870.jpg?fit=150%2C102&ssl=1","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZGa-Fp","_links":{"self":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/2567","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/comments?post=2567"}],"version-history":[{"count":0,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/2567\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/media\/2691"}],"wp:attachment":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/media?parent=2567"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/categories?post=2567"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/tags?post=2567"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}