Trying to understand different health insurance costs

I'm looking to purchase my first health insurance that doesn't come from school/family, so my main concern is estimating the total cost I will be paying for healthcare. To make things concrete, I will reference the numbers in this plan: https://www.blueshieldca.com/en/ifp/plan-details/silver-plans/silver-70-ppo

One thing I am confused by is copay vs deductible. When I search these terms (and look at other reddit posts) I get some basic definitions and examples but I have some questions about what happens in real life that never seem to be addressed completely and explicitly when others ask related questions.

Some standard definitions are (taken from https://www.cigna.com/knowledge-center/copays-deductibles-coinsurance ):
A copay (or copayment) is a flat fee that you pay on the spot each time you go to your doctor or fill a prescription.

A deductible is the amount you pay each year for most eligible medical services or medications before your health plan begins to share in the cost of covered services.

I have student health insurance right now with a $40 copay with the deductible waived for office visits, so I just pay only the $40 when I go to primary care/specialist whatever happens in that office. They could inject me with Captain America super soldier serum and I would pay $40 at the reception desk and I never get any bill afterwards (well I do sometimes get a bill, it has a bunch of costs and deductions and then bolded at the end is $0 owed). Does this change if I have the plan with the $5400 deductible (after we change $40 copay to that $50 copay if it's a primary care doctor and $90 for a specialist)?

More specifically, If I haven't met the deductible and I go to the primary care doctor in that blue shield plan and they do some minor procedure in office, do I pay:

(a) the $50 copay + the full cost of the medical services that are billed to insurance (ex. cost of the administering the super soldier serum)

(b) the medical services billed

(c) only the $50 copay, no matter what happens in that office

(d) Something else?

Same question if I do meet the deductible, except now the significance of the 70 in the plan name comes into play (it's supposed to give 70% off on covered expenses after the deductible, it's not explicitly stated in the link but on other parts of the website). If I go to the primary care doctor and do a minor procedure in office, do I pay:

(a) only the $50 copay, no matter what happens in the office

(b) 30% of $50 copay

(c) $50 copay + 30% of the medical services billed

(d) 30% of ($50 copay + medical services billed)

(e) Something else?

Questions 1 and 2 can be summarized by the following:

Are there other "medical services" that need to be paid for when you make office visits (primary care/specialist) besides just the copay? More generally, whenever you use insurance for a service where a copay is listed (ex. X-ray, labs, urgent care, emergency room), is that the only cost associated with the service? In other words, do you need to ever pay anything more than the copay for that service? And if so, how are these costs covered differently if you have met the deductible vs haven't met the deductible?

In the plan, there are only 3 places where I see an explicit difference between before deductible vs after deductible. 1. Prescription drugs 2. Maternity stay 3. Hospital stay.

(a) Are these the only places where you are paying "extra" medical expenses not explicitly listed in the tables? Ex. If you go to the emergency room, no matter what happens there, it's $450, there are no more costs associated with that (unless it transitions into a hospital stay)?

(b) Are these the only places where before/after deductible makes a difference in how much insurance covers (or how much you pay for the service)? (I assume you're not getting any discount on any copays on office visits, labs, imaging, emergency room, etc even if you've met the deductible).

(c) Are these also the only places where the cost of medical services contributes to the deductible?

This question can be summarized by: Are the medical services that involve copays and the medical services that involve the deductible disjoint?. In this framework, then the set of procedures involving copays are the things in the table with associated fees (office visits, labs, imaging, emergency room, urgent care) and you pay only that copay no matter what happens and that copay doesn't contribute to the deductible. On the other hand, in the set of procedures involving deductibles, the amount covered depends on before/after deductible, and whatever you pay contributes to the deductible.

submitted by /u/zhou94
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