Plan N Copays

The $20 is not a copay. It's the 20% of allowable for the office visit charge only with a maximum of $20. It could be as low as $12.

When the doctor collects $20 they may very well be over collecting.

Before I would pay the $20, I would ask the office how much Medicare allows just for the office visit code. Unless they say $100 or more, the "copay" won't be $20. Other services provided have no bearing on the cost.

Rick
 
The $20 is not a copay. It's the 20% of allowable for the office visit charge only with a maximum of $20. It could be as low as $12. When the doctor collects $20 they may very well be over collecting. Before I would pay the $20, I would ask the office how much Medicare allows just for the office visit code. Unless they say $100 or more, the "copay" won't be $20. Other services provided have no bearing on the cost. Rick

I don't get why they didn't just make it a copay rather than a coinsurance with a $20 cap, especially since they call it a copay. Given that at check-in, the normal time a copay is collected, the front window staff has no idea what the cost share will be, you're right they are likely to over collect, which they're not allowed to do.

I write a lot of N and my clients tell me the copay is usually not collected at time of service. When I present N I tell prospects it's called a copay but it doesn't work like the kind they're used to.
 
I don't get why they didn't just make it a copay rather than a coinsurance with a $20 cap, especially since they call it a copay. Given that at check-in, the normal time a copay is collected, the front window staff has no idea what the cost share will be, you're right they are likely to over collect, which they're not allowed to do.

I write a lot of N and my clients tell me the copay is usually not collected at time of service. When I present N I tell prospects it's called a copay but it doesn't work like the kind they're used to.

That's because the government group that made the rules doesn't understand the definition of "co-pay" which is usually a pre-determined amount for a service. Plan N really deals with "coinsurance" and is back billed. My clients receive bills in odd amounts like $8 or $13. The only thing the plan specifies is "up to" $20 for a physician's visit. Very confusing for clients who have been used to "copays" in regular group plans or other types of managed care.
 
That's because the government group that made the rules doesn't understand the definition of "co-pay" which is usually a pre-determined amount for a service. Plan N really deals with "coinsurance" and is back billed. My clients receive bills in odd amounts like $8 or $13. The only thing the plan specifies is "up to" $20 for a physician's visit. Very confusing for clients who have been used to "copays" in regular group plans or other types of managed care.

Yes, the "copay" is usually either around $4, $8, $13, or $20 depending on how the visit is coded and with a little variation geographically. $4 is rare. $13 and $20 appear to be the most common but I've heard a few reports of $8 as well. If doc codes it as $40, patient pays $8. Though confusing, it actually makes N a better value than appears, as many who do plan comparisons with G or F use the $20 figure for all copays, which should never happen if the doctor is coding visits properly.
 
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That's because the government group that made the rules doesn't understand the definition of "co-pay" which is usually a pre-determined amount for a service. Plan N really deals with "coinsurance" and is back billed. My clients receive bills in odd amounts like $8 or $13. The only thing the plan specifies is "up to" $20 for a physician's visit. Very confusing for clients who have been used to "copays" in regular group plans or other types of managed care.

Wow you know your right

I have been used to copays before I got into insurance
and I didn't have any issues understanding how this worked

But I have tried every way to explain this to prospects
and no mater what every once in a while
I get someone who just cant understand it

I just don't know what is so difficult about the concept
 
The $20 is not a copay. It's the 20% of allowable for the office visit charge only with a maximum of $20. It could be as low as $12.

When the doctor collects $20 they may very well be over collecting.

Before I would pay the $20, I would ask the office how much Medicare allows just for the office visit code. Unless they say $100 or more, the "copay" won't be $20. Other services provided have no bearing on the cost.

Rick

Just sell Plan F and you can forget this mumbo Jumbo.
 
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