Health insurance question

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SiggyPoke

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Nov 4, 2003
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#1
The wife has Health Choice health insurance through her work and when we go to the doctor and pay the $35 copay we still always receive a bill in the mail a week or so later from the clinic for remaining charges that insurance didn't cover. I've asked Health Choice about this and they say it's because we haven't met the deductible yet. I distinctly remember when we had BCBS through her previous job, we would go to the doctor, pay the copay and never receive a bill from the clinic for remaining charges. Has something changed with health insurance companies or does Health Choice simply suck?
 

oks10

Federal Marshal
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#2
The wife has Health Choice health insurance through her work and when we go to the doctor and pay the $35 copay we still always receive a bill in the mail a week or so later from the clinic for remaining charges that insurance didn't cover. I've asked Health Choice about this and they say it's because we haven't met the deductible yet. I distinctly remember when we had BCBS through her previous job, we would go to the doctor, pay the copay and never receive a bill from the clinic for remaining charges. Has something changed with health insurance companies or does Health Choice simply suck?
My wife has Health Choice and we've never had that happen, at least not with urgent-care type visits. She doesn't have a primary care doctor though if that's the type of visit you're referring to. When she was pregnant we paid extra for those doctor visits but that's a very different situation.
 

Duke Silver

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#3
The wife has Health Choice health insurance through her work and when we go to the doctor and pay the $35 copay we still always receive a bill in the mail a week or so later from the clinic for remaining charges that insurance didn't cover. I've asked Health Choice about this and they say it's because we haven't met the deductible yet. I distinctly remember when we had BCBS through her previous job, we would go to the doctor, pay the copay and never receive a bill from the clinic for remaining charges. Has something changed with health insurance companies or does Health Choice simply suck?
Was it out of network?
 

OkState1974

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Feb 6, 2007
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#4
It's possible you now have co-insurance in addition to co-pays. We have had that on our Blue Cross plan for the past two years.

Say your total bill is $150. You pay your $35 co-pay. Then you pay 20% (co-insurance) of the $115 balance or $23. Just another way to add to the employee cost. Welcome to 2022 Health Care Insurance.
 

UrbanCowboy1

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Aug 8, 2006
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#5
The wife has Health Choice health insurance through her work and when we go to the doctor and pay the $35 copay we still always receive a bill in the mail a week or so later from the clinic for remaining charges that insurance didn't cover. I've asked Health Choice about this and they say it's because we haven't met the deductible yet. I distinctly remember when we had BCBS through her previous job, we would go to the doctor, pay the copay and never receive a bill from the clinic for remaining charges. Has something changed with health insurance companies or does Health Choice simply suck?
Good question, but it's hard to say what's going on without more details. Could be out of network, could be co-insurance, could be a change in coverage. I would talk with your insurance carrier. Get ahold of an actual person, not a recording, and ask them - I've had pretty good results with United Health when I do that. Even get refunds sometimes.
 

SiggyPoke

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#6
Thanks for the helpful advice everyone. Health Choice did pay for a portion of the total cost, so perhaps this is a co-insurance situation in addition to the up front $35 co-pay?
 

oks10

Federal Marshal
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#7
Thanks for the helpful advice everyone. Health Choice did pay for a portion of the total cost, so perhaps this is a co-insurance situation in addition to the up front $35 co-pay?
Did you get a EOB for any of the visits? Also, I would think Health Choice would have a benefits summary that lays out how charges work for different plans and different services. My Cigna does but I've never looked into my wife's Health Choice.
 
Sep 3, 2022
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#9
HealthChoice is a PPO, where as BCBS is an HMO. It gets more complicated depending on whether you have HC High or HC Basic, but yes generally speaking you will have to pay a certain percentage of your bill until you reach your out of pocket maximum for the year.

The great thing about HealthChoice is you don't have to select a primary care physician and can go see just about any doctor or specialist you choose (you will pay more if out of network), and the premiums tend to be lower. The downside is that if you go to the doctor a lot it does feel like they are nickel and diming you. One other good thing about HC is there HealthChoice Select program. Under this program certain procedures, etc. are free (other than your premiums) if you choose a participating physician/clinic and/or hospital.

Go to the OMES website, they have plenty of info on HealthChoice and the fees you pay. You can also download the HC app.