How do deductibles work?
Deductibles are the first portion of a medical bill for which the insured is responsible. If you have a plan with doctor office copays, the copay “waives” the deductible, meaning that 100% of the doctor visit expenses are covered after the copay is paid. Expenses that are not covered with a copay, such as MRIs or surgery are subject to the annual deductible. This means that once the service is rendered the insured receives a bill from the provider and an explanation of benefits (EOB) from the insurer. The EOB will show the billed charges from the provider, less any applicable discounts the insurer is entitled to, less any charges the insurer paid, leaving the deductible and any applicable coinsurance. Remaining charges will show up on the bill from the provider, and it is the insured’s responsibility to make payment.
