What is the difference between deductibles and copayments?
A deductible is the dollar amount you must pay for covered services in a benefit period before benefits are payable by BCBSNC. You must satisfy your deductible amount once each benefit period. The deductible does not apply to any services where a copayment applies. A copayment is the fixed dollar amount you must pay for some covered services. The provider usually collects this amount at the time the service is provided. Copayments are not credited toward the individual or family benefit period deductible.
A calendar year deductible is the amount of covered medical expenses the member pays each calendar year before benefits are paid by the plan. A copayment is the fee charged to a member for a covered medical expense or for a covered prescription drug expenses. • How does my out-of-pocket maximum work? A plan may specify an out-of-pocket amount. Once the out-of-pocket maximum is met for the calendar year, the member is no longer responsible to pay coinsurance. • A provider has billed me; how do I know how much of the bill to pay? HMO, Open Access HMO, Elect Choice EPO, Open Access Elect Choice EPO For in-network claims, members are responsible for the copayment only. Part of our contractual agreements with network physicians include the requirement that physicians accept our payment, plus the member’s benefit plan copayment, or copayment percentage, as payment in full. Our physicians are instructed to collect the copayment amount listed on the member’s ID card. Any provider reimbursement
