I am enrolled in a PPO medical plan. My dependents and I have visited the doctor many times this year, but I was told by BCBS/Cigna that we haven’t met our annual deductible. How can this be?

With PPO medical plans, you pay a flat dollar amount (a copay) for many services, such as when you visit your primary physician, go to an urgent care clinic, or get a prescription filled. An example of a copay is $25.  Copays do not apply to your deductible but will count toward your annual out-of-pocket maximum.

You meet your deductible by paying out of pocket for medical services that require a deductible plus coinsurance until you reach your annual deductible amount.  Some services that require deductible and coinsurance are inpatient hospital care, outpatient surgery, x-rays, labs, and diagnostic tests, ambulance services, and durable medical equipment.   . Once you have met your deductible, you only pay a percentage amount (your coinsurance) for such services.  An example of coinsurance is 20 percent of the allowed amount for a covered service.

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