Am I Responsible for a Co-Payment?
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Am I responsible for a COPAYMENT?
Your relationship with your Primary Care Plus provider is important – promoting wellness and providing a consistent partnership focused on you and your health.
As a result of recent healthcare reform legislation, most health insurance plans allow you to receive certain eligible preventive care services without copayments or other cost sharing when these services are provided by an in-network provider.
This means that certain eligible preventive services, including screening, checkups and counseling, are covered with no out-of-pocket costs if you:
- See an in-network healthcare professional; and
- Receive only preventive care services during your visit.
However, you are responsible for a copayment, if your doctor provides non-preventive care services during the course of a visit – even if your visit was scheduled primarily for a preventive wellness exam.
A copayment may apply if you receive services such as:
- Treatment and/or counseling for a previously diagnosed chronic condition, such as high blood pressure or chronic obstructive pulmonary disease (COPD).
- Treatment and/or counseling for a newly diagnosed condition, such as an ear infection.
Your Primary Care Plus provider acts in the best interest of your health and well-being.
If you have questions about the services you receive during a visit, please talk to your doctor or call the member service number on your health plan’s identification card for clarification on your coverage.