An office visit co-pay can be a bit misleading. They are different depending on the type of health insurance plan you are on. A PPO co-pay works differently than an HMO co-pay. Most Arizona health insurance companies offer PPO's with office visit co-pays, while some companies do not even offer HMO plans at all.
So, what is the difference? Take a Blue Cross of Arizona HMO plan with a $20 office visit co-pay. Generally when you go to a physician or specialists office, whatever is performed in the office the physician charges will be covered by the plan co-pay, including if you are sent for lab work or an X-ray. When you go on an appointment whether it is for the flu, an annual check up, or you sprained your knee hiking. You can be certain your costs will not be much higher than the co-pay itself.
Now, for the PPO co-pay. For example, your plan has a $1,500 annual deductible with a $30 office visit co-pay. When you visit the doctors office, as a rule of thumb, you will pay everything towards your deductible except for the opportunity to meet with the doctor. If you need an immunization, or a blood test, or even an X-ray, these costs will most likely be out of pocket expenses which you will pay towards your deductible.
If a physician charges $120 for an office visit that means you will be charged $120 just to make the appointment. If you have an office visit co-pay, the $120 charge will be knocked down to whatever the co-pay benefit amount is.
So why choose a PPO style plan? A couple reasons; first of all the monthly premium will most likely be much less. PPO plans offer freedom of choice with physicians, specialists and hospitals. If you see a provider within the specified network your costs and coverage will improve. Anthem Blue Cross of Arizona and Blue Shield of Arizona for example, have close to 50,000 providers in their PPO networks.
The PPO office visit co-pay may not be as comprehensive compared to the HMO office visit co-pay, but the PPO plan is of much greater value to me and my family.
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