Sure, there’s a deductible with your health insurance. But then what’s the hospital deductible? Your insurer may have multiple deductibles, and it pays to know which apply when. These questions and answers tackle deductibles, whether an ex-spouse has to pay for an adult child’s insurance, and balance billing.
Recently I took my son to see a pediatric gastroenterologist. When I arrived at the office, I saw it was located adjacent to the hospital. My insurance has a large hospitalization deductible so I worried that the visit would not be covered. Nobody in the office could tell me how much an office visit would cost. Why not? Isn’t that something I should be able to expect?
Your plan’s hospital deductible won’t affect how much you pay for the visit to the specialist, whether or not his office is affiliated with the hospital, says Richard Gundling, vice president at the Healthcare Financial Management Association, a professional group.
Here’s how it works. Most health plans have medical deductibles that must be satisfied before the plan starts paying for most services. Preventive care is an important exception; there’s no deductible for that. Some plans like yours also have separate hospital deductibles. But your hospital deductible would generally only come into play if you were admitted as an inpatient.
“Even if the facility is hospital based, her visit would still be an outpatient procedure and wouldn’t affect her hospital deductible,” Gundling says.
Though your hospital deductible wouldn’t be an issue in this case, if your plan has a regular medical deductible and you haven’t yet satisfied it for the year, you may have to pay for the specialist visit anyway.
The doctor’s office should have been able to tell you how much the office visit would cost, Gundling says, but you may be better off checking with your insurer to find out how much you’ll actually owe out of pocket. Your insurer will have information about both how much it has agreed to
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