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[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]

That does sound shady. I would pass a note to your HR department that the “summary” is misleading for people who are in need of emergency care and least likely to have the time to crawl through full documents.

This is something that can easily be corrected by sticking an asterisk next to the ER copay that says “deductible applies”. [/quote]

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