United Healthcare Insurance?

Question

My husband and I have United Healthcare Insurance. We have a $1200.00 deductible. We have a 25.00 copayment. I was told that we only have to pay the copayment to see a doctor, that they would cover the rest, My question is what is the 1200.00 deductible for if we don't have to meet it before we can see a doctor.. I am confused...

Answer 1

You really should call member services and ask about your specific plan, because the deductible can be one of several things:
1. Hospital visits only (ER or admissions)
2. Labs and other procedures
3. A cost-sharing thing, where you pay your copay, United HC picks up a portion of anything done at the office, and you pay a percentage of that
4. Out of network providers (if every doctor or hospital or facility you go to is participating with United Healthcare, you don't need to worry about it - only if you see someone not listed as a provider.)

Because there's literally hundreds of varations of United Healthcare plans, you're better off asking the insurance specifically what pertains to your coverage.

Answer 2

Copayments generally apply to doctor's visits (there are usually separate copayments for prescription drugs as well); the deductible would go toward anything other expenses that are NOT covered by the copayment.

Let's say you go to the doctor and pay your $25 copayment. Your doctor's visit has been paid for (at least your portion of it.) Now, if you only see the doctor for something basic, that's probably all there is to it.

But if the doctor orders tests (xrays, MRIs, blood work or any other kind of lab work, etc.) those things are NOT covered by the copay. However, you will still receive a discount on those services as long as you choose a network provider. (And those network discounts can be significant.)

Even beyond the deductible amount, you may also have a maximum out of pocket amount. Most (not all) plans still require you to pay some portion of your bills even AFTER you meet the deductible. It's usually 10-30%, but that's completely plan specific. (Ask if you don't know.) That means that even after you reached the $1,200 deductible, you'd still have to pay some percentage of the bills until you reached the annual out of pocket amount. (And keep in mind, as a general rule, copayments for doctor's visits and prescription drug expenses do NOT count toward either your deductible, nor your maximum out of pocket expenses.)

Answer 3

Probably hospital stays.

I had United Healthcare for a few years ago. They were great. The co-pay is for in office doctor visits. The deductible is for hospitalization, surgery, lab work, etc.

But talk to your plan administrator if you're not sure. As someone else already said, United Healthcare has a ton of different plans so it's unlikely my plan would have been identicalto yours.

Answer 4

The 1200.00 deductible is generally applied to surgeries, hospital inpatient stays, labs, radiology, etc. Depending upon your plan it may also apply to perscriptions.

Answer 5

You're right to be confused. They're a great insurance company, but they have 20 different plans and you need to know which one you are on. I'd get a hold of your agent and demand to have that question explained. If your agent gives you a song and dance, contact UH directely.

Answer 6

If you are on a group plan, talk to your company's agent or read your Summary of Benefits.

If you have an individual plan, you have a policy. That is where you will find the answer.

You have a copay plan. It allows you to see the dr. for $25 for the visit.

Answer 7

the second answer is right the copay is for the quack and the deductible is for hanging out at the pond with all the other quacks.