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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]It sounds like OP does not understand their plan. Even “regular” copay style plans are imposing deductibles now in an effort to manage costs and steer patients away from going to the ER for things like ear wax buildup. (Sorry OP, I know you’re frustrated, but this is exactly why this is happening). What happened last year or on another plan is irrelevant to what your plan this year provides.

How it works is you pay your deductible in full first, then your co-insurance/copays apply for any visits your son might need to do later in the plan year.

You may or may not need to pay deductibles for everyone in your family. I’d suggest you get a summary sheet from your benefits department so you know exactly what is required under your particular plan. [/quote]

I'm op and no, this is not what happened: My plan - on the insurance site I always check to see who is in network, what copays are - lists copays for various visits including the ER. It is a very simple list, they are all listed together with zero mention of deductible. I have had many visits this year under this plan (my plan starts in June so it has been many months and all these claims are done, processed) and so have other family members: to PCP, specialists, urgent care/minute clinic, telehealth...All resulted in JUST a copay being paid, no deductible to be reached first before copays kicked in. So I assumed that as the ER was listed right along with the others, exactly the same way as the others, it meant it was the same.

When I went to the full brochure for my plan through my employer however, they had the same breakdown of various copays but added "deductible waived" next to PCP, specialists and urgent care and did not add it for ER. THAT is my mistake: I trusted the quick summary on the website and assumed that all the various visits listed along with their copays had the same set up. I should have checked, but I also think there is a defect here in not adding "deductible waived" for the quick summary which is what most people check. Info should look the same across all documentation.[/quote]

If the plan information doesn't say that ER (or any category) is exempted from the deductible, then the deductible applies. [/quote]
OP realizes that, but I agree with OP that “deductible waived” should be in the summary. People read the summary to find out what they will owe for the visit, so it is misleading to state only one cost (copay cost) for different types of visits if sometimes the deductible applies and sometimes it doesn’t. Or the summary should include an asterisk reminding the beneficiaries that the deductible is only sometimes waived, so check it as well. Misleading!! [/quote]

I have never seen a benefits summary that doesn’t advise you to look to the plan documents for specifics and not to rely on the summary. Also, unless the information provided didn’t advise as to a deductible, it’s hard to see how it’s misleading. Incomplete is different and is covered by the advise to look at the terms of coverage. [/quote]

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