Copays with Coordination of Benefits
Hi all, my first earnest Reddit post ever and it's because health insurance is so confusing. I've tried to find a similar situation to mine but could not after many hours of searching. This is in regards to coordination of benefits. I was originally under the impression that I should end up paying whatever the lower copay of the two insurances is, but that has not been the case. I've looked through plan documents, but they have not been very enlightening either. I'm going to use an office visit for this example.
Insurance 1 (Primary): national PPO, $500 deductible, $35copay (deductible does not apply)
Insurance 2 (Secondary): out-of-state POS, no deductible, $30copay (all out of state providers have the higher "preferred" copay)
Insurance 1 Claim (numbers adjusted for ease of use)
Amount billed: $300 Plan discount: $150 Plan paid: $115 Total amount owed: $35
Insurance 2 Claim
Amount billed: $300 Plan discount: $200 Paid by other insurance: $115 Plan paid: $0 Total amount owed: $0
I went to the doctor and paid a $35 copay. I want to see if this seems correct or if I should have paid the $30 copay applicable to my secondary insurance.
submitted by /u/Invader-Stim
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