The relatively small payment that you make for doctor visits and prescriptions. This payment has nothing to do with your deductible. So there is no need to keep track of your co-payment expenses.
The relatively large payment that you must pay before the company will pay benefits. The deductible has nothing to do with the co-payment.
First you pay the entire deductible then you keep on paying. A 70/30 to $10,000 plan means that after you pay the deductible, you continuing paying 30% of the next $10,000 which is $3,000.
Let's review. There is a $5,000 deductible and 70/30 to $10,000. Major illness, surgery, hospitalization occurs. You pay the first $5,000 of the bill then pay 30% of the next $10,000. Your total out of pocket expenses are $8,000 for that given year. That is it.
Out of Network Provider
A doctor (provider) who is not in the PPO list of the insurance company. If you use a doctor not on the list then it will cost you more money. The insurance company will still pay but at a lesser percentage, as well the negotiated PPO rate that the health insurance company is paying will be a much different rate than what the doctor is requesting. Keep it simple; see only doctors on the list if you can.
A doctor (provider) who is under contract by the health insurance company to see patients for a predetermined charge (rate, price). It is advantageous to you to use an in network provider.
Preferred Provider Organization. The insurance company will sign up hundreds, thousands or even hundreds of thousands of medical professionals to be part of their network. The larger companies will have doctors all over the United States.
Out of network Benefits
Even the biggest PPO will not have every doctor in the USA. If by mistake you go to a non-PPO doctor, the company will generally pay; let's say 60% of the bill based on their negotiated rates.
As an example, heart surgery,
The doctor will charge $20,000.
The negotiated rate would have been $10,000 for the surgery.
So the Florida health insurance company will reimburse you
$6,000 for the $20,000 surgery.
Go figure the deductibles and co-insurance and in the end you will realize that you should have gone to the PPO doctor.
The big PPOs have hundreds of thousands of doctors. Of course, life threatening emergency treatment is a whole different story per the contract. Just get your life saved and don't worry about anything else.
You can read much more at our Florida Insurance Guide. This is information you should know, and you won't find it anywhere else.