I'm stupid when it comes to insurance. Through my job I have BCBS health ins and I just got Dental. I am used to paying a co-pay with the Health Ins. I had some dental work done and asked if there was a co-pay to be settled while i was there. They said oh you mean the deductable. I paid that just wanting to take care of SOMETHING before I left. What is a deductable compared to a Co-pay?
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The short answer is: a copay is a set dollar amount that you pay at each visit. It is deducted from what the doctor gets paid. The deductible is an amount that you have to pay before the insurance pays anything. For example: If a doctor bills $85 for a simple sick visit, the insurance is contracted to pay $55.17 for that visit. (There's a negotiated rate for every participating doctor for every insurance - they have to take this payment, they can not expect anything extra.) If you have a $20 copay, the insurance is going to send the doctor a check for $35.17 - it's expected that your $20 copay will make up the rest of the $55.17. Now, for that same visit, if you have a deductible, you will be expected to pay the full $55.17, and the insurance will inform the doctor in writing that you are to be billed for and pay that amount. You will do something like that every time you see the doctor until your deductible is met. (And deductibles range from $50 to $5000 a year.) Now, if you have "co-insurance" - you'd be paying a percentage of the visit. (Of the $55.17, if your co-insurance is 15%, you pay $8.28, the insurance pays the rest.) Because insurance company contracted rates are WAY cheaper than cash prices, I advise people with deductibles and co-insurance to let their insurance be billed FIRST, because the insurance will figure out how much the patient owes. If they have a copay, providers are obligated to take that at the time of service.
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